Clinical Homeopathy Certificate Course Application

Please use the form below to submit your application for our Certificate of Homeopathy (C.Hom) clinical homeopathy certificate course. Before submitting your application form, please download and review the full course information packet.

First Name *

Last Name *

Mailing Address *

City *

State/Province/Prefecture *

Zip Code *

Country *

Home Phone

Mobile Phone

Business Phone

Enter your email address *

Occupation

Date of Birth

Time of Birth (if known)

Education Information

Institution Name and Location

Institution 1

Field of Study

Institution 2

Field of Study

Institution 3

Field of Study

Questions

Have you had any previous training in Homeopathy? *

Describe previous classes, experiences, seminars attended and/or books relevant to homeopathy

Have you had any previous training in any other health care profession? If yes, please describe.

How did you hear about LHI?

Please add a curriculum vitae or resume.

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Please include a recent photo.

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Applicant Verification Statement

I hereby verify that all information provided in this document and all enclosed materials are accurate and complete. I understand that any misrepresentation may constitute grounds for dismissal. Submission of this form constitutes a signed application.

Phone