The HERD Institute Application Form
Please fill in and submit this form to enroll in our Equine-Facilitated Learning or Equine-Facilitated Psychotherapy Certification programs.The HERD Institute undertakes to keep all your information confidential and secure, and will not share your information with third parties.
Email address *
We look forward to welcoming you to The HERD!
Applicant Name *
Date of Birth *
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Gender *
Date of Application *
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Street Address *
City *
State/Province/County *
Country *
Zip/Postal Code *
Phone number *
I am applying for enrollment in the following program: *
Required
My preferred payment method is: *
Required
Degrees and Qualification Held:
Please list Year, Institution, and Degree/Certificate Awarded
Post-Graduate and/or Additional Training Experience(s)
Please list: Year, Length of Program, Name of Program
What attracts you to The HERD Institute? *
Please describe your experience with horses (please include any riding experience): *
What do you hope to gain from this training? *
Please provide a Personal Statement about yourself and your experience: *
Do you have any special needs or dietary requirements, while you are at the training? (Please check all that apply) *
Required
Please provide details for 3 referees (2 academic/professional, and 1 personal)
Please provide the following details for each referee:

Name:
Profession:
Phone:
Email:

Referee 1 *
Referee 2 *
Referee 3 *
Please use this space to provide any further information you feel may be relevant:
Please email a copy of your most current resumé to info@herdinstitute.com *
Required
Declaration
By entering my name in the Applicant Electronic Signature box below, I declare that all the information I have provided is true and complete to the best of my knowledge and that The HERD Institute has my permission to obtain all necessary information from the references I have listed concerning my past experience and I release all parties from any possible damages resulting from disclosing such information with or without prior written notice from me. I understand that this application does not constitute a contract of any kind. Should the HERD Institute enroll me, I may terminate such enrollment at any time.
Applicant Electronic Signature (Please print name below)
Thank you for your application! The team at The HERD Institute will be in touch soon.
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