Level 1 Program Application Form

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

How did you hear about the program?

What ethnic or racial background do you identify with?

What sparked your interest in plant medicne?

Please describe your herbal education to date. This includes all current, prior or future herbal school training as well as the length of time.

What level of experience do you have working with plants?

List all herbal reference books you rely on.

What are your perspectives of plant medicine, wellness, and healing wholistically?

How do you plan to use the knowledge you obtain to change the narrative within your community?

How much time are you willing to devote to this program?

Do you have any schedule conflicts that will cause you to miss live class Mondays at 7:00PM EST?

I understand I must be present for all classes and my camera must be on.

If you are accepted into the program are you willing to the complete all work by the assigned deadline?

What skills and tools do you hope to receive from this program?

I name understand the importance of showing up for myself. If accepted into the program I will fully committed to the process.

I blanks understand that all payments are non refundable and may be transferred to future classes.

Did someone refer you to us? If so, please include their name!

I understand that programs as What Grandma Said start at $699 and payment plans are available.

Signature