Certification – Healthy Believer Conference

Please fill up this form to apply to become a Healthy Believer Certified Trainer.

Personal Information

First Name*
Gender*MaleFemale

Last Name *
Birthdate *

Contact Information

Address*
City*
Postal Code*
Primary Phone*

Address 2
State/Province*
Country*
Email*

Church Information

Church/Ministry Name *

Senior Pastor *

Current Level of Involvement*

Employment/Organization Details

Name of Organization or Company*
Organization Website
Address*
City*
Postal code*

Job Title*
Country*
Address 2
State/Province*

Training/Professional Experience

Please tell us about your educational background, degrees earned, names of granting institutions, and other trainings you've completed:

Please tell us if you have any teaching or ministry experience:

Please tell us if you have any coaching or training experience:

Have you taken a Health Believer Conference, Intensive or Training?
YesNo

Personal Questions

Why would you like to become a certified Healthy Believer Trainer?

What value could you add to the team?

What are your personal, ministerial and/or career goals?

What is your personal testimony?

Referrals

Please list three (3) referrals and their contact information below:

First Name
Phone Number

Last Name
Email

Please describe in a few words the relationship you have with this person ?

First Name
Phone Number

Last Name
Email

Please describe in a few words the relationship you have with this person ?

First Name
Phone Number

Last Name
Email

Please describe in a few words the relationship you have with this person ?

The fields marked * are mandatory