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Last name*

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I can dedicate the required time to succeed in this program.

I am unable to dedicate the time needed to complete the program as scheduled and would require additional time to complete it.

I am unsure of the time commitment required for this program and would like to speak with an Team Member.

What best explains your reason for wanting to enroll in this program?

I'm seeking a profound personal journey to reach my full potential and create a lasting impact on the world.

I aim to develop my leadership skills to promote group cohesion, resilience, and workplace harmony.

I am interested in improving and expanding my skills and knowledge as a health practitioner.

I am considering this as a career path.

Other

If Other, please provide information

Educational Background - Include life experience and prior learning.*

ACKNOWLEDGEMENT AND SIGNATURE

Your seat is reserved once you've submitted a completed application, attended a one-on-one meeting with Dr. Stephanie Shelburne, Executive Director, and paid the $100 application fee.

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Date

By submitting this form, I consent to the New England School of Bioenergetic Medicine contacting me via email, phone, and/or text to discuss education and services offered. I understand my consent is not required to attend NESBEM.

My consent may be withdrawn at any time. Reply STOP to opt out.

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