Congratulations!

You Have Completed The Requirements For ICBCH Professional Hypnosis Certification.

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

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Name(Required)

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Address

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I have completed all of the requirements from my ICBCH training instructor

True

False

I agree to abide by the ICBCH Code of Professional Ethics

True

False

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:

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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

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 copy of previous Certification OR Documentation of 100 hours of Hypnosis Specific Training

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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 ICBCH Professional Hypnosis Certification.

To access your certificate of ICBCH 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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