Certification Application

Name*

First NameLast Name

Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth*

Date

Phone Number*

Email*

example@example.com

Confirm Email*

example@example.com

Why are you interested in learning hypnosis? (what draws you to this training-be as detailed as possible*

Have you experienced hypnosis before?*

YesNo

If yes, please describe your experience:

Do you plan to use hypnosis professionally, for personal growth, or both*

Professionally as a Hypnotist/HypnotherapistMy personal growthBothEnhance another professional skillset

Hypnosis is a powerful tool for deep transformation. In your own words, what does integrity mean to you when working with someone’s subconscious mind?*

A client shares something deeply personal with you. How would you ensure confidentiality, trust, and ethical responsibility in your practice?*

Hypnosis requires focus, responsibility, and respect for the subconscious mind. Have you ever had an experience where you realized the power of your words or actions in influencing someone? How did you handle it?*

This program is designed for individuals committed to doing deep work—either for themselves or for others. If accepted, are you ready to commit to personal accountability, emotional depth, and a professional approach to hypnosis?*

Yes, 100%No (if no, then thismay not be a fit)

What concerns (if any) do you have about hypnosis or this training?*

Please read carefully and acknowledge the following statement:

While many students experience profound personal transformation through this training, this program is designed to teach professional hypnosis skills, not to resolve personal challenges. It is not a replacement for private hypnosis, therapy, or mental health treatment. If you are seeking hypnosis to address personal challenges, it is recommended that you work with a private hypnotist before or alongside this training.

Do you understand and accept these terms?*

Yes, I understand that this training is for learning hypnosis and not for solving personal issues.No (If no, this may not be the right fit.)

Is there anything else you’d like to share about your personal or professional background that would help us understand if this is the right fit for you?*

Were you referred?*

YesNo

If yes, please share who referred you:

By submitting this application, I acknowledge that:

I understand hypnosis is a professional tool and not entertainment.
I am committed to ethical, responsible, and respectful practice.
I am ready to engage in deep personal and/or professional transformation.
I acknowledge that this training is not a replacement for personal hypnosis or therapy.

When you hit submit, you will be redirected to schedule an interview. Be sure any pop-up blockers are disabled. If you are not redirected, book your interview call at https://pennychiasson.as.me/interview. We look forward to working with you on your journey into the subconscious and the potential we all have.*

I understand

Hypnosis Certification Application