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Global TCM Education Provider Application Form
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* Indicates required question
Email
*
Your email
Application Type
*
New Provider
Provider Renewal
Required
Education Provider Type
*
Individual Provider
Organizational Provider
Required
Name (First and Last Name, if individual provider)
*
Your answer
Coordinator Name (First and Last Name, if organizational provider)
*
Your answer
Phone
*
Your answer
Mailing Address (Street number and name, Apartment or unit and its number, City, state, and zip code)
*
Your answer
Credentials (please provide
highest academic degrees earned, specialty, and state acupuncture license number. Also, please send your CV to globaltcm@globaltcm.com)
*
Your answer
I understand that along with this application form, I need to submit my CV to the following email address:
globaltcm@globaltcm.com
*
I agree
Required
Course Description [including course title, objectives, hours offered, course outline, teaching methods (i.e., video, PPT, text, audio, etc)]
*
Your answer
Do you have experience in teaching similar subject matter content within the five years preceding the course?
*
Yes
No
Other:
Required
Do you have experience of at least two years (within the last five years) in the specialized area in which you are teaching?
*
Yes
No
Other:
Required
I certify under penalty of perjury under the laws of the States that I and the CE Provider organization I represent in this application have read and will comply with the continuing education regulations, and that all statements contained in this application are true and correct.
*
I agree
Required
A copy of your responses will be emailed to the address you provided.
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