Hypnotherapy Certification Application

Hypnotherapy Certification Application

Please complete the following application to be considered for our hypnotherapy training program.
Full Name*

First NameMiddle NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Shipping Address (We keep this on file so we can send your Certificate here upon Graduation)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
How did you hear about this certification?*
What inspired you to pursue hypnotherapy training?*
Which of the following resonates the most with your reason for pursuing a hypnotherapy certification?*

Personal use, self-transformation and educationAdd to my existing practice of other modality as an add-onStart hypnotherapy practice and see clientsOther
What do you hope to create or change through this certification?*
On a scale from 1–10, how entrepreneurial are you?*

1

2

3

4

5

6

7

8

9

10

1 is 1, 10 is 10
Why did you choose that number above?*
What’s your long-term vision for how you’ll use hypnotherapy (e.g., private practice, coaching integration, retreat work, online programs, etc.)?*
Have you trained in any other healing, coaching, or therapeutic modalities?*

YesNo
If yes, which ones?
How comfortable are you using online tools (Zoom, Online Learning platforms, email, etc.)?*

Very comfortableSomewhat comfortableI’ll need some support
How many hours per week can you dedicate to training and practice? (Students who can commit at least 6-8 hours a week can graduate in around three months)*
What’s your plan to stay accountable and complete the program? (Describe your accountability plan)
Are you financially prepared to invest in your training?*

Yes, I’m ready to enrollYes, but I’d like to discuss payment optionsNot at this time
What type of support helps you perform best?*

AccountabilityFlexibilityCommunityMentorshipOther
What’s one thing you’d want us to know about you as we review your application?
Link to your website, social media, or professional profile (Optional)
If accepted, are you ready to commit fully to your training?*

Yes, I’m ready to go all inNot yet
Type a question
If you were referred, please share their name below!
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