First name
Last name
Email
Multi-line address
Country/Region
Address
City
Zip / Postal code
Phone
What Extra Lesson training have you done? Please give name of training program and dates.
Do you have a certification from the training?
Yes, certified
Statement of hours attended
If available, upload your credential file here. Otherwise, email a copy to su@healingeducation.org.
Upload your file
Choose a file or drag and drop one here.
Upload File
How have you used your training? Check all that apply.
Work in a school as an Extra Lesson teacher
Work in a school as a class teacher or EC teacher
Work as an independent consultant
Work in a private practice
Other
Please elaborate on your response to the last item. Include the name of your current or most recent employer.
What are your goals in applying for this program? *
Which sessions do you plan to attend? Check all that apply.
All six sessions
Sept 26
Oct 24
Nov 21
Jan 23
Feb 27
April 3
If you are in need of our limited tuition assistance, please include information as to why it is needed.
Do you have any extra funds to share with someone who might need assistance with this course? If so, thank you for ‘paying from your heart’! Please indicate how much extra you can give:
Do you have a ‘buddy’ that would be also attending? If so, please note that your buddy has to also submit an application, and should list you as their buddy. Please tell us your buddy's name and email address:
Submit
Refresher
