Level 1: Becoming Energized Instructor Application

Level 1: Becoming Energized 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 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 1 Instructor Certificate? *
What was the date of your Quantum-Touch Practitioner Certification? *

MonthDayYear
Date
Do you have a preferred Level 1 Instructor Trainer?
For a full list of Level 1 Instructor Trainers, go to: https://quantumtouch.com/en/instructors
Please Share Your Quantum-Touch Level 1 Workshop History

If your practitioner certification included two Level 1 classes, you will need to attend two additional Level 1 workshops for a total of four Level 1 workshops. Please complete the form below by listing the completion date, instructor name, and whether the workshop was in-person or virtual for each Level 1 attended. Please also upload digital copies of your Level 1 workshop certificates.

End Level 1 Workshop History
Please Upload Digital Copies of Your Level 1 Workshop Certificates

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Please Share Your Quantum-Touch Advanced Level (Levels 2-5) Workshop History

To qualify as a Quantum-Touch Level 1 Instructor you need to complete at least two advanced Level workshops (Levels 2-5). Please complete the form below by selecting the workshop Level, then filling out the instructor name, completion date, and whether the workshop was in-person or virtual. Please also upload digital copies of your advanced workshop certificates.

Please Tell Us About Yourself