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 need to be paid in New Zealand dollars.