Professional Herbalist Training Program Application

Complete the following form and submit when ready. You will be able to review and edit this form after submitting. Please note, once the application is submitted, you will need to print it out, sign it, and mail it in with two letters of recommendation and a two hundred dollar deposit. You may also download the application form to print and fill out by hand. Please include two letters of recommendation and the phone numbers of three to four work related and/or personal references. If necessary, the letters of recommendation may be mailed in separate from the application.

Name:
Address:
City, State, ZIP:
Email:
Work Phone:
Home Phone:
Date of Birth:
Place of Birth:
Gender:
Social Security #:
Prior Education (please include high school, college, and herbal education)
Institution / From-To / Degree / Date Received
What college level science classes have you taken?
Describe your work experience:
Employer / Your Title / Job Duties / Hrs per wk / Length of Employment
Do you plan to work while attending the PHT program?
If so, how many hours a week do you plan to work?
What is your occupation?
What length of time have you had this job?
How do you plan to pay for the Professional Herbalist Training Program?
Can you pay for the program and books in full by the January 1st, 2009?

Both the PHT Program and the Clinical Case Studies Program are demanding of one’s time and energy. If you apply and are accepted, are you prepared to make the commitment needed to be successful in the program?

Provide the following information:

Please write a statement of purpose:
Why do you want to take the PHT Program?
What interests you in deepening your knowledge of and experience with medicinal herbs?
What is your current plan for utilizing the training once you complete the program?
How did you hear about the NWSBS programs?

Emergency Contact Information

In the unfortunate case of an emergency, please include the name, number, and address of two people may be contacted, as well as your relationship to each person.

First Contact
Second Contact