APPLICATION FORM

Personal data:
Name
Address
Phone/fax   -  Business/Home
Email address
Date of birth
Living in relationship with other/s
Children

Describe your present occupation: (How fulfilling is it?)

Educational Background:

Experience in distance learning or correspondence course:

Brief history of any experience in personal growth, counselling or Psychosynthesis:

What books have you read that have impressed you the most:

Briefly outline two or three incidents in your life which have caused you to take a new direction:

What do you want to achieve for yourself through doing Psychosynthesis Distance Education:

Please send in completed application, with registration fee of $100 and a recent personal photograph, to Psychosynthesis Distance Education (see contact page for details). To register with the Psychosynthesis Trust in New Zealand fees may be paid in New Zealand or Australian dollars.