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Intentional Touch™ Certification

Application
 

To apply:

  1. Complete this application in one of three ways:

    1. Complete on-line at www.thecerioinstitute.com and click submit at the end

    2. Print the application from our website, complete, and mail to The Cerio Institute
                                                                                                                 P.O. Box 65
                                                                                                                 Soquel, CA 95073

    3. Call the office at (831) 475-5472 and request an application be sent to you through the US mail. Complete and return to the address in 2.

  2. Submit the following in hard copy through the US mail

    1. Curriculum Vitae

    2. One copy of your certification/s and/or  degree/s

    3. One copy of your license/s

    4. Two Letters of Recommendation

      1. 1 from a client

      2. 1 from a professional familiar with your work

    5. A $50 non-refundable application fee payable to The Cerio Institute

 

When we receive your completed application, we will contact you and set up an interview.

 

Please provide the following information about yourself:

First Name:
Middle Initial:
Last Name:
Street Address:
Address (cont.):
City:
State:
Zip:
Home Phone:
Work Phone:
Cell Phone:
Web Page:
E-Mail:
Occupation:

 

Have you ever had your Health Care License been revoked? If yes, attach details.

Yes   No

Have you ever been convicted of a felony? If yes, attach details.

Yes   No

 

Please provide the following information about your Health Care Practice:

Your Title:
Practice Name:
Length of Time
in Business:
Licenses if Any:

Street Address:
Address (cont.):
City:
State:
Zip:
Work Phone:
Fax:
Web Page:
E-mail:

 

List certifications in the Health Care field:

List other work experience in the Health Care field:

Why do you want to study Intentional Touch™?

How do you see yourself using Intentional Touch™?

What is your experience with clients suffering from: sexual abuse, post-traumatic stress disorder, serious long term illness, chronic mental, emotional and/or physical pain?

Why are you interested in working with this population of clients?

What is your experience working in settings that partner conventional and alternative medicine?

 
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