Section 1: Personal Information

First Name *

Last Name *

Date of birth *

Email *

Phone (with country code) *

City, Country Serving In *

Gender *

Nationality *

Section 2: Ministry & Cross-Cultural Experience

How many years have you served in cross-cultural ministry? *

0-2 Years

3-5 Years

6-10 Years

11-15 Years

16+ Years

What countries have you served in cross-culturally, and in what capacity? *

Are you currently serving in full-time ministry? *

Yes

If yes, please describe your current role and location

What has motivated you to pursue training in debriefing? *

Section 3: Counseling, Debriefing, or Member Care Background

Have you personally received a Le Rucher-style debrief? *

Yes

Strong recommendation: Being debriefed by a certified Le Rucher debriefer beforehand greatly enhances participants' preparation and confidence in understanding both the 'why' and 'how' of the approach.

If Yes, Answer the Following Questions

When did it take place?

Who facilitated your debrief? (Debriefer name and/or organization)

Have you received any previous training in trauma care, crisis response, or mental health? *

Yes

Are you currently offering care, coaching, or counseling to others in your ministry or organization? *

Yes

If you answered 'Yes' to either question above, please provide details below.

Section 4: Expectations and Availability

What are your expectations for this training? *

Does your organization have any expectations about how your role might evolve after this training? Please Explain *

Are you available to attend the full in-person training? *

Yes

Would you be interested in doing follow-up supervision, coaching, or further training after this event? *

Yes

Do you have any physical, dietary, or learning needs we should be aware of to help you get the most out of the training? *

Where will you be traveling from? *

Are you applying as part of a sending organization or independently? *

Is there anything else you’d like us to know? Please share any additional information here.

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