Unstoppable Me Certification Application Form

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Use this form to apply to take the Unstoppable Me Program Leader Certification Program

Name *

Please provide your first and last name

Phone Number *

Please provide your phone number

Email Address *

Please provide your email address as contact info

Current Occupation & Education *

Please describe your current occupation and your education. List all degrees and relevant certificates, etc.

Course Details *

What is the nature of your interest in pursuing the CAN Life Coaching Course (check all that apply)

To run Unstoppable Me programs in my community

To use Unstoppable Me program within my existing role with children

Personal development and to use skills with my own family

Other:

Required

Describe your interests further

Please take a moment to further describe why this course is of interest to you, including what you hope to gain from this course.

Where did you hear about us? *

Facebook

Twitter

Newspaper Ad

Magazine Ad

A Former Student Told Me About the Course

A Friend Told Me About the Course

I saw a presentation or took a class with Dr. Mandy Wintink

CSI website

Other:

Required

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