Section I Full Name (required) Email (required) Phone Number (required) Website (if applicable) Have you attended an approved EFT Level 1-2 training? If yes, then who was your trainer and what year did you attend? Please list other modalities you are trained in including certifications and licenses you currently hold How many years have you been in practice? At this time please send two professional references. These can be clients you've worked with, a mentor you’ve used in your training, or a combination of the two. Ask them to send you a letter of recommendation along with their contact information in case I have any questions. Please type "Yes" to confirm that you will send these as an email to firstname.lastname@example.org Section II The following are required for completion of your EFT Relationship Coach Certification and are included in the tuition: 1 Choose one of the following: Read How to Want Sex Again book, take PathtoPassion.com course for specializing in Sex and Intimacy Take LearningtoFindLove.com course for specializing in Dating/Mate Attraction Take WhentoEndit.com for specializing in Couples Work Or decide to do all the above at once (to be discussed with Alina) 2 Complete EFT Level 1-2 approved training or repeat Level 1-2 if deemed necessary. 3 Upon acceptance of the applicant’s Application, he/she will be required to sign the EFT Relationship Coach® Certification Program Participation & Release Agreement. 4 Attend and participate in six 1:1 live monthly teleconference calls. (More as deemed necessary if wanting to learn all 3 tracks at once) 5 Successfully complete Tapping Out of Trauma 8 week webinar course. 6 Sign the EFT Relationship Coach Certification Agreement. 7 Conduct a minimum of 3 case studies exclusively using EFT based on the themes and topics of the Program, 2 written case studies and 1 case study videotaped. Case studies will be solely evaluated by the Program Director. 8 Successfully complete Ethics, Legal Issues & Risk Management Strategies for EFT Practitioners self-paced online course. 9 Participants in the Program are required to complete a minimum of 3 case studies (2 written, 1 videotaped/filmed) exclusively using EFT based on the themes and topics of the Program. After reviewing the case studies, it is possible that the Program Director may decide, in her sole discretion that the participant has not demonstrated a level of competency to continue in the Program. In such event, the Program Director shall notify the participant of such decision and it’s possible other recommendations may be made to the participant at that time. For example, the participant may be required to submit additional videotaped/filmed sessions or receive individual mentoring, such costs to be solely by the participant. If it is decided that the participant will not continue in the Program, the participant may be entitled to a partial refund depending on how far along the participant is in the Program. 10 The participant must obtain written permission from the subject who appears in the videotaped/filmed case study. The participant will be provided with a Permission Letter for this purpose. The participant must send to the Program Director a signed Permission Letter before the Program Director will review and evaluate the videotaped/filmed case study. 11 In order to graduate from the Program the participant must have completed all the requirements and have demonstrated proficiency in the required skills. Such proficiency will be assessed solely by the Program Director. 12 An optional cohort 3 day retreat will be scheduled on Whidbey Island towards the completion of the program. Tuition includes accommodations. Section III Fees Application fee to be applied towards tuition $100 to be paid at the time you submit the application. Tuition for the Program - $5000, includes administrative costs, series of 6 live teleconference calls, review & evaluation of case studies, including 1 case study to be videotaped, and Permission Letter for participant to use when obtaining permission from the individual being videotaped for the case study for review and evaluation. Additional fees may include Tapping Out of Trauma Course 8 week webinar course ($399) and Ethics, Legal Issues & Risk Management Strategies for EFT Practitioners self guided course ($125). Please Answer 12+8=?