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APPLICATION FORM
School of Remembering
Awakening the Illuminated Heart
(ATIH)Teachers Training WorkshopApril 21th- a! "rd# 2$1"#
%hapala# &'I%
IRTA*T+ plea,e t!pe in !our information# ab,olutel! no
handwriting on the Applicationorm
First Name (legal
name)_Vernice_______________________________________________________
Last Name(legal name)
__Santos_______________________________________________________
.ate of /irth+000arch 22# 1"000000000000000000
lace of /irth (cit! and countr!)
000%hicago#Illinoi,000000000000000000000000000000000000000000000
ale+0000000000emale+000'00000000
ccupation+00Student# part time Securit! 3aurd and part time
,tore clerk4
Home phone+0051-62$-55700000000000000000 %ell phone+
0000051-62$-5570000000000
a8+00000000000000000000E!ai"+0_#ernicesantos$g!ai"%co!__________0
Addre,,+ 00007$12 %lark 9ane Apt : 2$600000000000
%it!+ 00%olumbia000 State;proSA0000000000000000000000
*ame;phone of a per,on to contact in a ca,e of emergenc!+
0009il! Santo,000000000000000000000000
hone0051-226-"6000%ell phone00*one00
mailto:[email protected]:[email protected]:[email protected]
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P"ease ans)er the -o""o)ing .&estions
note: please read A## !estions $aref!lly %efore answering" Add
more spa$e& %ypressing the ret!rn key& as needed to answer
ea$h !estion $ompletely"
14 hich Awakening the Illuminated Heart work,hop did !ou
attendG
note: we are asking a%o!t ATIH workshops and NOT a%o!t the
Ad'an$ed workshop
1,t ATIH work,hop+ .ate 00000000000000000000000
lace00000000000000000000000000000000000000000
ATIH
teacher+0000000000000000000000000000000000000000000000000000000000000000000000000000000000000
2nd ATIH work,hop+ .ate+ 0000000000000000000000 lace
0000000000000000000000000000000000000000
ATIH
teacher+0000000000000000000000000000000000000000000000000000000000000000000000000000000000000
24 Are !ou a 9 facilitatorG !e, 0000 no0'
"4 Are !ou currentl! teaching the lower of 9ifeG !e,0000
no0000
64 If not# which 9 work,hop(,) did !ou attend and who wa, !our
facilitatorG
note: we are asking a%o!t lower of #ife workshop and NOT
Earth/Sky/Heart workshop
.ate of 9 work,hop+ 00000000000000000000000
acilitator+ 000000000000000000000000000 %it!+
00000000000000000000000
I ha
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!e, 0'0 no 000000000
if !e,# date+ 000000000000000000000000
4 Hanit! %on,ciou,ne,,
grid00000000000000000000000000000000000000000000000000000000000000000000000
124 How long ha
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154 Ha
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Note: all pages %elow (e$ept Intake orm and Statement) are for
yo!r informationON#*" *o! do not need to send them to !s with yo!r
appli$ation"
What to inc"&(e into *o&r app"ication
note: only appli$ants who s!%mitted A## re!ested do$!ments and
$ompleted A##prere!isites will %e $onsidered as $andidates for the
training program" It is $ompletelyyo!r responsi%ility to make s!re
that yo! are sending all do$!ments ne$essary" +e willNOT %e a%le to
re!est missing do$!ments or missing information in the
appli$ationform"
/% Co!p"ete( APPLICATION FORM% On"* app"icants )ho atten(e( t)o
ATI')orkshops0 rea( ,r&n#a"os 1ooks0 practice( Creation -ro!
the 'eart !e(itationan( st&(ie( FOL )orkshop !a* 1e consi(ere(
-or the registration%
2% A hea(shot photo 3 *o&rse"- on"* an( NOT in a
gro&p4%
5% Cop* o- *o&r passport 3a page )ith *o&r na!e0 photo0
(ate an( p"ace o- 1irth an(*o&r signat&re4
6% Signe( Intake -or! 3attache( 1e"o)4
7% Signe( State!ent 3attache( 1e"o)4
A ,election committee will carefull! re
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IRTA*T+ the ,election proce,, will be ba,ed on !our
?ualification, onl! and not onthe time when !our application wa,
recei
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Workshop an( acco!o(ation costs
The Teacher@, Training ork,hop co,t i,+ M1# >S.
Accomodation fee i, ,eparate and will be around M1#7$$ >S.
(lodging# all meal, and u,e ofhotel amentitie, are included)4 ou
will ha
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SC'OOL OF REMEM9ERIN;
