International Medical and Dental Hypnotherapy Association

Master’s Center and the Institute of Hypnosis Sciences Inc.

Bucks County Community College

Hypnotherapy/Hypno-Counseling Instructor Training Course Application

 

Mailing address

Master’s Center

PO Box 67

Fairless Hills, PA. 19030

215-295-8062

masters@masters-center.com  /  www.hypnosiscenter.ORG

All information must be completed. If some information is "The Same" (e.g.: business and personal address)  then type "Same" in that field/box. 

 

 

Personal Contact Information  
   
First Name: 
MI: 
Last Name:

Mailing Address:

City:
State/Provence:
Postal Code:
Country:
Email Address:
Web Site:
   
Office Contact Information:  
   
Office/Business Name:

Mailing Address:

City:
State/Provence:
Postal Code:
Country:
Email Address:
Web Site:
   
Hypnotherapy/Hypno-Counseling credentials and the name and phone number(s) of each provider:
List all relevant continuing education completed within the last 2 years and the name(s) and phone number(s) of providers
Do you currently have an active practice Y/N:
What is the primary focus of your practice:
How many hours per week do you practice on average:
List any previous experience as an instructor
(Be specific):
Supply 3 personal references. Include name, phone number and email address:
Supply 3 Business references. Include name, phone number and email address:
   
  Required: Please forward copies of your certification certificates and any CEU/continuing education certificates or documentation to us via email or postal mail (address above). (Email is preferred.) When by email use jpeg or GIF format. Acceptance to the course is contingent on approval of previous training documentation.  
 

Note: Acceptance to this course is at the discretion of Master’s Center and the Institute of Hypnosis Sciences Inc. and IMDHA.

 

    Please note: Graduates must successfully complete all academic, practical and financial requirements of the course and pass a final exam to receive certification (e.g.: enrollment does not in itself guarantee graduation or certification). Final exam may be retaken up to 3 times if a student is unsuccessful in passing the final exam. All required enrollment forms, class policy forms etc. must be completed and on file with this office prior to entering the course. Those accepted are required to purchase their course materials in advance in preparation for the 5 day onsite class and will be required to pass an entrance quiz to demonstrate that he or she has in fact studied the materials in preparation. This is to assure that class time can be used in the most efficient manner. The entrance quiz may be repeated up to 5 times if needed but must be successfully completed prior to attending the onsite class. Students who do not complete this requirement will not be admitted to the subsequent class. There are no refunds for materials and standard pro-rated tuition refunds apply. In the event that a student fails to successfully complete the entrance quiz there are 2 options. (1) A partial tuition refund. (2) re-take the exam and enter the next cycle of the class. Graduation makes the graduate eligible to teach as a regional instructor for the hands-on portion of the basic certification course approved by IMDHA, Master’s Center and Bucks County Community College. Those instructors accepted will be assigned to teach in a specific geographic area through Master’s Center as approved independent contractors for the purpose of preparing students for the online portion of the course and providing hands-on mentoring for the purpose of preparing students for graduation in line with the approved curriculum. Graduates must teach at least 1 class each year and are required to complete a 2 day instructor refresher course every 2 years to retain approved instructor status.

 

    I attest that the information provided is truthful and accurate and understand that falsification on my application may, at the discretion of the program administrator(s), result in being dropped from the class with no refunds of materials or tuition.  I have read and understand this document and further agree that if accepted to abide by all standard class policies and procedures. I further attest that I am over 18 years old.

    
  Applicant electronic signature or typed full name