Professional Herbalist Training Program Application | The Northwest School For Botanical Studies

Authenticity *

Yes

I certify that the information recorded in this application and all other application submissions are true and correct. Otherwise, I understand that I may be dismissed from the School.

Basic Information

Note: We will never share your private information

Name *

Address *

City *

State *

Email *

Phone *

Date of Birth *

Month

Day

Year

Place of Birth *

Background

The following information is optional, but please provide all that you can.

Prior Education

Please include high school, college, and herbal education

Institution

From-To / Degree / Date Received

Coursework

What college level science classes have you taken?

Work Experience

Please describe your Employer / Your Title / Job Duties / Hrs per wk / Length of Employment

Concurrent Work

Do you plan to work while attending the PHT program?

Work Hours

Occupation

Length of Employment

What length of time have you had this Job?

Payment Method

Can you pay for the program in full?

Yes

Committment

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

Please 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

Contact's Name *

Phone *

Address *

Relationship *

Second Contact

Contact's Name *

Phone *

Address *

Relationship *

References

Please include the phone numbers of three to four work related and/or personal references. All information is kept confidential.

First Reference

Name *

Phone/Email *

Please input the best way to get in touch with your reference. This must be the phone number of email address of your reference.

Second Reference

Name *

Phone/Email *

Please input the best way to get in touch with your reference. This must be the phone number of email address of your reference.

Third Reference

Name *

Phone/Email *

Please input the best way to get in touch with your reference. This must be the phone number of email address of your reference.

Letter of Recommendation

Files must be less than 5 MB.
Allowed file types: txt rtf pdf doc docx.

Your photo

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.

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