Advance Apprenticeship Application
General Information
Name
First Name
Last Name
Preferred Pronouns
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Age
Birthdate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Emergency Contact Name
Emergency Contact Phone Number
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Course Interests
What option of the Advance Apprenticeship are you applying for?
Option 1: Both materia medica and practitioner path
Option 2: Materia Medica Pathway
Option 3: Practitioner Pathway
Have you taken classes with Rachael? If so, which ones?
What herbal programs have you completed prior to this?
Do you have any medical experience?
(i.e. classes in human anatomy or physiology, WFA or WFR certification, Western Medical certifications, etc.)
Do you have any experience in botany or ecology?
(i.e. classes in botanical ID, college degrees, eco certifications, etc.)
What are you hoping to learn?
How do you see the intentions of this program being integrated into your life?
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Course Logistics
Are you able to attend all of the classes? If not, how many do you anticipate missing?
Are there any scheduling conflicts?
Do you have any health concerns that may affect your participation in the program?
Any other comments/inquiries/helpful information?
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Work Trade
Please fill out if you would like to be considered for work trade.
Describe financial need for work trade position:
Are you part of a marginalized group?
Are you able to do manual labor outside? Are you able to work in the herb kitchen? Are you able to work on the computer? Do you have a preference?
Are you able to work for 3 hours on Wed or Thurs during weeks of program?
Yes
No
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