Wig Medical Certified CPS Instructor Application
Complete this 10-minute application to apply for the Certified CPS Instructor cohort and confirm your course and hosting readiness.
Contact
Full name
*
First Name
Middle Name
Last Name
Email address
*
example@example.com
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
City and state
*
Business or practice name
Website
Instagram handle
TikTok handle
Credentials
Have you completed the Wig Medical CPS Certification course?
*
Yes, I have completed it
No, I am still in progress
No, I have not enrolled yet
Month and year completed
Have you attended a Wig Medical live one-day certification event in person?
*
Yes, I have attended
No, but I am registered for an upcoming event
No, not yet
Do you hold an active cosmetology or barber license?
*
Yes
No
State that issued your license
Are you currently a member of the CPS Society?
*
Yes
No
Not sure
Practice experience
Are you currently practicing as a Cranial Prosthesis Specialist?
*
Yes, actively seeing clients
Yes, but only occasionally
Not yet, still building my practice
Approximately how many clients have you fitted for a cranial prosthesis?
*
None yet
1-5
6-15
16-40
More than 40
Have you submitted insurance claims for cranial prostheses?
*
Yes, and I have been reimbursed
Yes, but not yet reimbursed
Not yet
Teaching and hosting
Which market would you like to host events in?
*
DMV (DC, Maryland, Virginia)
New York
Chicago
Houston
Los Angeles
Nashville
Another market
If another market, specify the city
Do you have experience teaching, training, or speaking to a group?
*
Yes, regularly
Yes, occasionally
No, but I am ready to learn
What classes, workshops, or events have you hosted?
Why do you want to host Wig Medical certification events in your market?
*
How would you promote an event to reach licensed cosmetologists and barbers in your area?
*
Commitment
Can you commit to posting collaboratively with the Wig Medical account on a weekly basis year-round?
*
Yes
No
I would like to discuss this
How soon would you be ready to host your first event?
*
Within 3 months
3-6 months
6-12 months
Not sure yet
Anything else you would like to share
Submit Application
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