Training Certification Application - Carolyn Bucey Eberle

The Mind Energy Body School of Transformation is not for everyone. It exists solely to support those who are deeply committed to their own transformation so that they may be of authentically empowered service to others. Please complete the following application and you will be contacted for an interview to make sure we are a good fit.
Many blessings! I look forward to meeting you!

First Name *

Last Name *

Email *

Phone *

Address *

City *

State *

Postal Code *

Date of Birth *

Occupation/Job Title *

Have you ever been treated for a mental illness or disorder? *

Yes No

If yes, please provide details *

Describe your drug and/or alcohol use *

List any prescription medications you take *

How did you hear about us? *

Success in the Mind Energy Body Transformation(TM) Guide Certification Program is dependent on your ability and willingness to explore personal issues that can at times be challenging.

Are you willing to do deep emotional work & take responsibility *

Yes No

*Drug and Alcohol Policy: You are learning to self-regulate pain to power, and to accomplish this we use 5 skills and 5 steps to awaken higher consciousness. Therefore, no drugs (other than prescribed medication) or alcohol are permitted during class weekends including 24 hours prior to your arrival.

Your answers are bound by our Privacy Policy and are strictly confidential.

The Mind Energy Body School of Transformation, LLC does not discriminate in any way on the basis of race, color, age, gender, national origin, religion, sexual orientation or disability.

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