Student Homework Form
STUDENT INFORMATION
Information about the student submitting the homework.
Student First Name *
Your answer
Student Last Name *
Your answer
Student Email Address *
DOUBLE CHECK FOR ACCURACY! This is where a copy of your homework will be sent and where the instructor will reply with comments!
Your answer
Select Class *
Required
PARTICIPANT INFORMATION
Healer Name *
Your answer
Client Name *
(or just initials)
Your answer
Client Relationship to Healer *
Your answer
Client Presenting Complaint
(if known)
Your answer
Client Age
(if known)
Your answer
Client Gender *
Required
THE HEALING
Date of Healing *
MM
/
DD
/
YYYY
What Did You Notice About the Client Before the Healing?
(if anything)
Your answer
What Happened During the Healing? *
Your answer
Describe What You Were Feeling/Thinking During the Healing *
(transference)
Your answer
Guidance Information
(something you were drawn to do and don't know why)
Your answer
What Did You Notice About the Client After the Healing?
(if anything)
Your answer
Client Response/Feedback
(if any)
Your answer
TURN IN YOUR HOMEWORK
Click "submit". A copy of your homework will be emailed to you and to the instructor.
Submit
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