Step One: Student Registration Form

Please provide the following information and click "Submit" to send this Student Registration Form to the Academy:

*Today's Date
click on calendar icon -------∆

*First Name

*Last Name

*Degree(s)

*Occupation

*Primary Email

Secondary Email

*Daytime Phone

*Street Address

*City

*State

*Zip Code

*Country

Professional Licensure If you are licensed by your state to diagnose and treat, please list your license(s) and the state(s) that grant them:

Professional Specialty What particular therapeutic approaches do you utilized and/or what special problems do you treat:

Professional Affiliations List any hospital, academic, institutional, governmental organizations with which you are affiliated:

*Intentions How and in what capacity do you intend to use your training in IGIsm:

When you have completing this form, click on the "Submit" button below. To clear all fields, click on "Reset."

*Required

After you have submitted this Student Registration Form, make sure you have also prepared the following documents:

(1) Complete the Student Contract which you can view online by clicking here and download by clicking here. Please read, sign, and return it, making sure that you agree fully with all the terms and conditions associated with Professional Certification Training. The Student Contract is a formal agreement between you and the Academy and it lists the requirements for Certification, tuition costs, fees, safeguards, protected terms, and other Academy policies. It cannot be completed online and a written copy must be hand signed and returned to the Academy.

(2) Submit a copy of your state license to practice as a health professional, if you have one, or a copy of your student ID card if you are a student pursuing a credential that will lead to a professional license.

(3) If you do not have a professional license, please submit a brief (one to two page) application letter describing your goals in learning IGI^sm; your plans for using it; your access to psychological consultation or supervision, if needed; any previous training or experience you've had in counseling or coaching; and a copy of your CV or resume.

(4) You may return these completed documents to the Academy as email attachments to train@acadgi.com or by FAX (800-727-2070), courier service, or US Mail. All enrollment documents must be received and fees paid before any advanced training materials will be sent.

After preparing these documents, go to Step II and choose the program(s) in which you wish to enroll by clicking here.


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