Level 4: Becoming Heart-Conscious Instructor Application

Level 4: Becoming Heart-Conscious Instructor Application
Please Enter Your Contact Information
What is your name?*

First NameLast Name
What is your billing address?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What is your preferred email address?*
example@example.com
Phone Number

Country Code (001 for United States)Area CodePhone Number
How would you like your name to appear on your Level 4 Instructor Certificate? *
Do you have a preferred Level 4 Trainer?
Please Share Your Quantum-Touch Level 1 Teaching Experience

Enter you Quantum-Touch Level 1 Instructor Certification date and list 10 of the most recent Level 1 workshops that you have taught. Please include completion date, # of students, and if you taught the workshop virtually or in-person.
What was the date of your Level 1 Instructor Certification?

MonthDayYear
Date

End Level 1 Workshop History
Please Share Your Attendance History for Quantum-Touch Level 4 (Formerly Level 2)

Please include the completion date, instructor, and whether you attended the workshop virtually or in-person. Please also upload a digital copy of each certificate.

End Level 4 Workshops
Please Upload Digital Copies of Your Level 4 Workshop Certificates

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Please List 5 Insights or Healings You Had During Your Self-Healing Practices Using Level 4

(from the 50 hours of documented self-care sessions)
Insight #1 *
Insight #2 *
Insight #3
Insight #4
Insight #5
Please upload your 50 hour self-healing form here. *

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Please Enter Your Contact Information