; Quantum-Touch Practitioner Application Checklist
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Quantum-Touch Practitioner Application Checklist


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    Please complete this application and send with your completed requirements to the address below

Name: _________________________________________________                      Date: _____________________

Address: ___________________________________________________________________________

City: _________________ State/Province: _____________________ Zip/Postal Code: __________

Country: ___________________________________________________________________________

Phone # (include Area Code or Country/Region Code): _______________________________________

Email for QT Business: _______________________________________________________________

1) Date of Certified Practitioner Status: _______________________________________

   Basic Quantum-Touch Workshops that you have completed and attach copies of the

      a) ___________________________________________________________________

      b) ___________________________________________________________________

      c) ___________________________________________________________________

      d) ___________________________________________________________________
   * Note: Only TWO of the FOUR Basic Workshops can be Facilitated Interactive Video Workshops.

3) Write the DATE, INSTRUCTOR NAME, and LOCATION of the Advanced QT Workshop
   that you have completed.
      a) ____________________________________________________________

4) Print TWO copies* of the “Quantum-Touch Certified Instructor Agreement.” Keep one for
   your records. Read, sign, and return one (ALL 9 pages) to the QT Home Office.
    *Contact QT for a copy of the agreement.
    Attach the signed “Certified Instructor Agreement.”

5) Pay the one-time Instructor Registration Fee of $150 USD.
    U.S. Instructors may provide a check, money order, or credit card information. International Instructors may
    provide credit card information, or send a money order or cashier’s cheque in USD. QT accepts Visa or
    Credit card #: ______________________________ Exp: __________________
    Attach check, money order, or cashier’s cheque, if applicable.
6) At certification, your existing Practitioner Bio will be used to create your Instructor Bio. You
   will also be provided a log-in with which to edit your Instructor Bio.
    Please limit bios to 250 words.

7) How would you like for your name to appear on your certificate?


8) Please answer the following.
    Use additional sheets of paper if needed.
  * Note: The QT Instructor Program will use the following information to best support you in manifesting your
    greatest success as a Certified QT Instructor.

      a) Briefly describe your introduction to Quantum-Touch.

      b) What inspires you to become a Certified QT Instructor?

      c) Describe your experience with teaching students in a workshop setting.

      d) Describe your experiences of teaching energy healing with others.
       e) Do you have special interests with which you want to share? We will keep these special
          interests in mind for future programs and projects.

Attach all paperwork to this application and mail your completed instructor requirements to:
          Attn: Instructor Certification
          P.O. Box 512
          San Luis Obispo, CA 93406

Upon certification by the Instructor Program Director:
   1) You may advertise yourself as a Certified Quantum-Touch Instructor.
   2) You may schedule your first Live Basic Workshop. (Students will only receive course credit from
      Certified QT Instructors.)
   3) You will receive a certificate that states you are a certified Quantum-Touch Instructor.
   4) You will be highlighted (with optional photo) as a certified instructor on the Quantum-Touch
      website, where your contact information is provided for referrals.
Allow 3-4 weeks for certification.
You will be notified of your status as a Certified QT Instructor via email.
For questions, contact: instructor@quantumtouch.com

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