Level 3: Becoming Whole Instructor Application

Level 3: Becoming Whole Instructor Application
Please Tell Us About Yourself
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 phone number? *

Country Code. 001 for United StatesArea CodePhone Number
What is your preferred email address?*
example@example.com
Why do you want to become a Level 3 Instructor?*
Do you have a preferred Level 3 Instructor Trainer?*
Please Share Your Quantum-Touch Level 1 Teaching Experience

Provide 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 3 (Formerly Self Created Health)

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 3 Workshop Certificates*

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Please Share Your Experience With the Level 3 Practice Circles

The true gift of Level 3 lies in seeing life through the lens of Becoming Whole—recognizing the Inner Healer’s messages in your relationships, health, beliefs, finances, and spiritual self. Practice circles help deepen this awareness.
Have You Attended at Least 15 Level 3 Practice Circles?*

YesNo
Please share insights you've received during the Level 3 Practice Circles: *
Thank You for Completing the Application!

Quantum-Touch, Inc. will review your application and follow up soon regarding your next steps. We’re honored to be part of your journey.
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Please Tell Us About Yourself