Congratulations!

You Have Completed The Requirements For NLP Practitioner Certification.

To access your certificate of NLP membership and your certification certificate, please complete the following:

Step 1 of 2

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Name(Required)

First Last

Email(Required)

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code Country

List your highest academic degree (if applicable):

University Name:

(ICBCH requires all members who hold advanced degrees represent themselves only with degrees that are accredited by an agency recognized by the US Department of Education and in foreign countries, by appropriate governmental departments of education)

Year of Graduation:

List your professional license(s)/certification(s) - if any:

Type

State

Type

State

Have you ever been convicted of a felony?(Required)

Yes

(If yes, attach a full explanation.)

(NOTE: Although a prior felony conviction will not automatically disqualify one for certification, any person with a prior felony conviction for moral or sexual crimes against children, or sexual violence against adults, or other felonies as deemed inappropriate for certification by the ICBCH will not be certified by the ICBCH. Failure to disclose criminal history will result in revocation of credentials, and is an act of perjury. If you have questions on this policy, please contact our office prior to completing the course materials.)

Full Explanation

Have you ever had a professional license or certification revoked, suspended or denied in any state or by any certification board?(Required)

Yes

(If yes, attach a full explanation.)

Full explanation

Are you required to register on any sex offender registry in an jurisdiction or country, or have you previously been required to register at any time?(Required)

Yes

(If yes, attach a full explanation.)

Full explanation

Please enclose a legible photocopy of a government issued photo ID, i.e. driver's license, passport, professional license, military ID.

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Max. file size: 256 MB.

Attach a copy of your certificate of completion from your NLP training class

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Max. file size: 256 MB.

Read and sign your acknowledgement:

I hereby certify that the information provided above is true and accurate. I am applying to receive recognition as a Certified Professional Hypnotist. I understand that this certification recognizes specialized training in the required subject matter and does not provide the authority to offrter client services apart from the existing requirements of my state of residence. I agree to practice within the scope of my education, experience and training and to provide client services consistent with the ethical standards of ICBCH, my respective professional designation(s), and within state or national law in your region. Certification certificates remain the property of the ICBCH and must be surrendered in the event of revocation by the Board.

Signature(Required)

Congratulations!

You Have Completed The Requirements For NLP Practitioner Certification.

To access your certificate of NLP membership and your certification certificate, please complete the following:

List your professional license(s)/certification(s) - if any:

Read and sign your acknowledgement:

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