HermesLongevity Educator Application Form
Welcome to AI Wellness Center of Excellence for Education! Please fill out the form below with as much detail as possible to help us understand your expertise and how you can contribute to our mission of providing comprehensive lifestyle solutions and education.
Personal Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Professional Title (e.g., MD, DO, NP, PhD)
*
License Type
*
Please Select
MD
DO
NP
PA
RD
PT
Psychologist
Licensed Therapist
Other
State/Country of Licensure
*
Years of Experience
*
LinkedIn Profile or Professional Website
Optional
Professional Background and Expertise
Select Your Primary Areas of Expertise
Regenerative Medicine
Mental Health
Fitness and Nutrition
Anti-Aging
Functional Medicine
Integrative Wellness
Chronic Disease Management
Other
Practice/Clinic/Institution Name
Location
Role/Position
Have You Previously Taught or Created Educational Content?
Yes
No
Please Describe Your Experience
Upload a Sample of Your Educational Content
Browse Files
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Choose a file
Optional - (File upload option; PDF, DOC, PPT formats)
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of
Content Creation and Engagement
Which Topics Would You Like to Contribute To?
Anti-Aging Medicine
AI in Healthcare
Precision Nutrition
Mental Wellness
Regenerative Medicine
Fitness Innovations
Hormone Optimization
Other
Preferred Methods of Content Contribution
Yes
No
Are You Willing to Collaborate on Co-Branded Content with Brands in the Marketplace?
Yes
No
Are You Comfortable Engaging with an Audience During Live Sessions?
Yes
No
Are You Comfortable Engaging with an Audience During Live Sessions?
Yes
No
Digital Avatar Interest
Are You Interested in Creating a Digital Avatar to Enhance Your Educational Presence?
Yes
No
Please Explain Why You Want to Create a Digital Avatar and How You Envision It Enhancing Your Engagement with Learners and Patients
200-word limit; prompt to consider the benefits of increased accessibility, personal branding, and interactive learning experiences
Compliance and Platform Policies
Are You Able to Comply with HermesLongevity’s Guidelines on Ethical Education and Data Privacy?
Yes
No
Impact and Community Involvement
Why Do You Want to Become an Educator on HermesLongevity?
Are You Interested in Supporting Community Impact Initiatives through Your Educational Content?
Yes
No
Preferred Causes to Support Through Your Work
Veterans
Orphaned Children
Cancer Research
Muscular Dystrophy
Environmental Sustainability
Other
Technical Requirements and Availability
Availability for Content Creation and Live Sessions
Please Select
1-5 hours
6-10 hours
11-20 hours
20+ hours
Preferred Times for Live Sessions or Webinars
Mornings
Afternoons
Evenings
Weekends
Flexible
Do You Have Access to High-Quality Recording Equipment (e.g., Camera, Microphone)?
Yes
No
Do You Need Assistance with Technical Setup for Content Creation?
Yes
No
Final Steps and Submission
Is There Anything Else You Would Like Us to Know About Your Qualifications or Interests?
How Did You Hear About HermesLongevity?
Please Select
Social Media
Colleague Referral
Industry Event
Website
Other
Submit
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