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Application for an Additional Year

of the WPFC Basic Seminar in Bowen Family Systems Theory

Please complete this application using a word processor, saving your work as you go along.

The text areas for your responses are shaded in light grey and will expand as needed.

When finished, e-mail the completed application as an attachment to info@ before August 1st.

You may then arrange payment of the course fee with the WPFC office.

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CONTACT INFORMATION

|Name: | |

|Address: | |

|City/State/Zip: | |

|Country: | |

|E-mail: | |

|Phone: | |

PROFESSIONAL AFFILIATION

|Employer: | |

|Job Title: | |

Type an ‘X’ in the boxes that best describe

your professional background:

| |Clergy |

| |Educator |

| |Family Business Member |

| |Medical Worker (e.g., nurse, physician, physician’s asst.,|

| |etc.) |

| |Mental Health Worker (e.g., counselor, psychiatrist, |

| |psychologist, social worker, etc.) |

| |Organizational Consultant |

| |Student |

| |Other (please specify): | |

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Looking back over your experience of studying Bowen theory and applying it to the research of yourself-in-system, what learning has been most significant for you?

What areas of learning do you want to pursue during an additional year of the WPFC Basic Seminar in Bowen Theory?

How will you work toward your objectives for learning?

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