Application for Cohort Dates: February 26 – April 30

First Name *

Last Name *

Phone *

Email *

This program is selective and by application only. Please answer thoughtfully. Clinical reasoning and professionalism matter most here.

Professional Background

Primary Discipline / Credential

State(s) of Licensure / Certification and #

Years in Professional Practice

Primary Modalities Used

Current Practice Setting

Clinical Experience

Populations You Primarily Work With

Have You Worked With Performing Artists?

Regularly

Occasionally

Not Yet

Performing Arts Populations

Dancers

Instrumentalists

Vocalists

Variety / Circus / Ariel / Pole

Describe a Challenging Clinical Case You’ve Worked With, What Was Your Thought Process?

Clinical Reasoning & Scope

When a client isn’t responding as expected, what is your next step?

How do you determine when a case is outside your scope of practice?

What does “assessment” mean to you clinically?

Professional Intent & Learning Goals

Why do you want to work with performing artists specifically?

What do you hope to gain beyond clinical techniques?

What feels most challenging in your current clinical work?

Program Commitment & Professional Pathway

Interest in NewPath / Performing Artists Injury Treatment Center (PAITC)

Interested in internship / employment

Education Only

Open / Undecided

Are you open to feedback and supervision?

Yes

Can you commit to the full 10-week program?

Yes

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