Personal Development
Professional Accreditation
Hospital & Health Care
Education Sector
Coaching - personal training
 
What is Stress?
The Science behind HeartMath
emWave Technology
 
emWave Products
Stopping Emotional Eating Program
Online catalog
HeartMath Store
search engine by freefind
 
FOCUS
Transforming Stress
Enhancing Personal Growth
RESOURCES
Featured Product
Books, CDs, e-Books
Download Stress e-Book
emWave®PC Movie
FAQs About HeartMath
Self Care Presentation
SERVICES
Personal Training Courses
1:1 License Training
Keynotes, Special Events and Presentations
GETTING STARTED
The HeartMath System
What You Can Do
Results

 

1:1 Provider Application Form

 
Please complete the form below.


Name:


  Date:


Occupation:


Business name:


Type of business:


Business address:


Business phone number:


Other work phone numbers:


Fax number:


E-mail address:


Alternate e-mail address:


Home address:


Home or mobile phone:


Do you prefer to receive HeartMath materials at your office or home?


Who is your primary HeartMath contact?


What HeartMath products or services have you used?
Include all HeartMath workshops or seminars you have attended and when.


What professional training have you received? Please include degrees, certifications and licenses held and dates completed.

What professional organisations do you belong to?


What is your professional experience working with individual clients in a 1 on 1 format? Please include dates. (e.g. I'm a wellness counselor and have been working with individual clients for 10 years. Currently I have about 10 clients a week and we meet face to face.)


Why do you want to become a 1:1 Provider?


How many people do you plan to teach HeartMath to within the next 12 months?


Describe your targeted market and your relationship to that market.


Give a brief résumé-type history of relevant profession, education and employment information in addition to that mentioned above.


Please list contact information for 2 references.
Professional

Name:

Phone:

organisation and title:



   Personal

Name:

Phone:

organisation and title:



When you complete the 1:1 Provider training you will receive a certificate of completion. How would you like your name to appear on that certificate? e.g. Jane Smith, Ph.D.

Maria Thompson
Director, Training and Licensing Programs
HeartMath LLC
6 Help Street/ Level 7
Chatswood 2067, NSW Australia


*1:1 provider license does not allow for training groups or conducting any type of workshop or seminar.
*1:1 provider license is only available to residents of North America, Australia and New Zealand.

Submission of this application indicates that you have agreed to the following:
*I understand the submission of this application form alone does not guarantee acceptance into the 1:1 Provider Program.

*I agree that upon completion of my training as 1:1 Provider I will follow the terms and conditions stated in the 1:1 Agreement.

Sample License Agreement
1:1 FAQs
Application Form

For Information
Telephone: (02) 9412 2500 (Australia)
Fax: +61 2 9403 7900
E-Mail: info@macquarieinstitute.com
Top

Macquarie Institute is the Licensee company for Australia and New Zealand of the HeartMath LLC organisation headquartered in North America.

Self Care Center | Health Professionals | Health Care Systems | HeartMath Store | emWave®
Home  | About Us | Privacy & Security  | Alliances  | News/PR  | Contact Us  | Feedback

Copyright © 2007-2011, Macquarie Institute All rights reserved.