CD2 Application - Conscious Discipline

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Are you ready to attend the Conscious Discipline Advanced Institute? As you know, the Advanced Institute is a small, limited-attendance event that provides a unique opportunity to learn and grow with Dr. Becky Bailey.

The purpose of the Advanced Institute is to explore and deepen your understanding of Conscious Discipline in an intimate group setting. It is also a stepping stone for those who intend to become Conscious Discipline Certified Instructors or Ambassadors, or to share Conscious Discipline in their school, agency or organization. (Please remember that participation in the Advanced Institute is not a guarantee of certification, and only Certified Instructors are permitted to charge a fee when sharing Conscious Discipline.)

The following questions will help you determine if applying for the Advanced Institute is the next step in your journey with Conscious Discipline:
- Am I aware of my intentions?
- Am I confident in using Conscious Discipline skills during upset and conflict?
- Do I have a clear understanding of the Conscious Discipline Brain State Model?
- Am I comfortable sharing my implementation journey?
If you answered a resounding “yes” to all of these questions, please complete the information below to apply for a space at this life-changing experience. If you felt uncertain about any of your answers, please rejoin us at the Summer Institute and other events as you continue to deepen your learning.
Please check to continue*
- I have read and accept the above.

Accept This Invitation
- Only completed invitations received by October 31, 2019 will be considered.
- If your invitation is accepted, you will receive notification by November 15, 2019.
- Those who are accepted will have two weeks from their notification date to complete the registration process in order to guarantee their space at the event.
- Spaces are not transferrable.
Personal Information
Name*
First Last
Email*
Cell phone*
Work phone
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Gender
Race
Work Information
Name of school/agency/organization*
Type of school/agency/organization*
Your title*
Your role/position*
Age group you work with*

Conscious Discipline Experience
Please limit your answers to two paragraphs each (approximately 200 words or 1500 characters).
What year(s) and location(s) have you attended the Conscious Discipline Summer Institute?*
Have you been a helper at the Summer Institute? If so, list the years and sessions.*
How long have you implemented Conscious Discipline in your position and with what depth?*
Describe the impact of Conscious Discipline in your school/agency/organization.*
Where do you envision your Conscious Discipline journey taking you?*

Conference Details
Your Baby Photo*
Accepted file types: jpg, png, pdf.
Photo/Video Participant Releases
If you have photos/videos of individuals in your presentation or poster session display, a signed release for each individual must be completed. Please upload executed release(s) here.
Drop files here or
Preferred Roommate
Roommates will be assigned to most double occupancy rooms. If you have a preferred roommate, please list their first and last name here. If you do not have a preference, leave blank.
Special Notes
Do you have any special items, like documented medical food allergies? If so, please list here.

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Accept This Invitation

Personal Information

Work Information

Conscious Discipline Experience

Conference Details