Healers Training Application

Healer's Training Application
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Prerequisites
Must be enrolled in current medicine wheel and will remain in until completion. Click session number completed.

Session 1Session 2Session 3Session 4Session 5Session 6
OR in what year did you complete Medicine Wheel? 20year.
Requirements
By signing below, you acknowledge the following graduation requirements:
• Private healing sessions with the training facilitator will address the wounds and blockages that may arise during our work.
• Monthly private mentoring sessions with your Ayllu (Pod) leader.

These sessions are included in the tuition and will occur between workshops throughout the duration of the program.
Date

MonthDayYear
Date
Signature

Clear
Please describe as thoroughly as possible:
Training/Certifications (For example, Aromatherapy, Carpentry, CPR, Computer Programing, First Aid, Massage, Other Shamanic training, Reiki, Website Building/Maintenance, Welding, etc.,)
Employment History & Business Experience
Why do you want to participate in Healers Training?
What do you hope to gain from it (goals)?
Education/Schooling (Level of school, degrees/certifications completed)
How do you plan to integrate this into your life and work?
Have you or are you actively working with a therapist, counselor, psychologist, ect?
Have you or are you actively working with a Rising Fire Practioner?
Should be Empty:

Healer's Training Application

Prerequisites

Requirements

Please describe as thoroughly as possible: