Breathe! Application Unique IDThis application should take about three minutes to complete.Guidelines of ParticipationPlease read through these Guidelines of Participation and signal your agreement by checking the box below.If you are one of the 50 selected educators for Breathe!…You will receive further program information, including specific retreat dates to choose from this spring.You will then select a date and invite two friends (one of which should be a co-worker from your school) to join you in this wellness initiative.These friends will be eligible to participate at no cost, but will not be awarded the $200 Wellness Grant.They will become your Breathe Team.All three of you will sign up online.You will need to turn in a W-9 prior to receiving your $200 Wellness Grant (these will be available at the retreat).After your retreat, we will need a simple, one-paragraph description of WHY you are choosing to invest your grant money in this way.You will be asked to participate in three, one-minute online, confidential surveys consisting of 6 yes/no questions. (Simple!) We will send you an email prompting you to take each survey.Your Breathe Team will be asked to gather once a month for six months for small group reflection and discussion over the book Vantage Point that each participant will receive.PGPs and CEUs available. If you are not one of the 50 selected educators for Breathe!…You will still be eligible to participate in this teacher wellness initiative and will receive $40 off the $80 program fee.This initiative includes a half-day retreat (not a seminar, but a refreshing retreat), the book Vantage Point, and 6 months of support through one-page, online “Join the Journey Tips and Tools.”PGPs and CEUs available. Agreement to Guidelines of Participation* I agree to these Guidelines of Participation Personal InformationName* First Last Email* Enter Email Confirm Email Home Address* Street Address City State / Province / Region ZIP / Postal Code Phone*Professional InformationSchool District*Name of School*Number of years in education…*Please enter a value greater than or equal to 0.Current Position*Elementary SchoolMiddle SchoolHigh SchoolAdministrationProgram ParticipationRetreat Location Preference*The Summit on Rudisill Ave. on the south side of Ft. WayneCamp Lutherhaven – a retreat center near Chain-O-Lakes State Park (Albion, IN), about 35 minutes nortwest of Ft. WayneEitherProgram Preference*Faith-Sensitive – works well for people of all faith backgrounds or no faith backgroundFaith-Focused – works well for people with a Christian faith backgroundEitherRetreat Timing Preference*Select all times that would work for you. Sunday afternoons from 1:30 to 6:00 During the week from 12:30 to 5:00 Spring Break In the month of June, after school is out When is your spring break?*In five sentence or less, please describe what overload feels like in your life right now.*NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms. Breathe! is powered by Ambassador Enterprises.