Screen Time Clinic® Digital Wellness Educator "Member" & Collaborative Referral Partner Application
Thank you for your interest in joining our internationally recognized team of Screen Time Clinic Certified Digital Wellness Educators and/or Referral Partner to help families thrive. STC Certified Digital Wellness Educators will have access to our resources, courses, presentations, and consideration to utilize our flagship TechXpress™ Digital Detox program as a licensed facilitator. 

Our core company values are honesty, compassion, and "real talk" to prevent & reform digital addictions, improve mental health, encourage healthy "human" lifestyles, strong family bonds, and connected communities.

Please complete this form PRIOR to scheduling your interview to be considered joining the Screen Time Clinic® collaboration team to help more families and individuals learn the real risks and benefits of modern digital media via engaging presentations and 1-1 transformations.  .
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Email *
How did you hear about us!? Who may we thank for your referral?
How are are you interested in collaborating?
First Name *
Last Name *
Degrees Abbreviations (MBA, Med, BS Counseling, etc) *
What is your current job title? *
What is your current company (if any)? *
What other credentials/trainings have you accomplished particularly relating to teaching, childhood development, psychology, and/or wellness?   *
LinkedIn Profile Link *
What city and country do you live in? To be listed on the map if approved. *
What is your birthdate (month and day) so we can recognize your special day! "MM/DD" format please *
STC Certified Educator applicants: How many hours per week do you realistically intend to devote to building your digital wellness education speciality or potential volume of referring clients for collaboration? 
Share with us a little insight about your work with children or youth groups?
Tell us why you think you (or your company for collaboration) would be a good advocate/partner for safe & balanced digital media?  How do you envision being a Digital Wellness Educator/Consultant/Coach or referral partner and building your local network? What scope to you see yourself undertaking this collaboration?  *
Please list your personal and/or other business social media accounts.  Honesty, transparency and kindness are our core company values.  *
Any other questions about membership or collaboration?  There is no fee to become a referral partner however we are very selective about offering membership for those who qualify for certification which may have a fee if you do not have other formal trainings in digital media. Learn more about this in our interview if selected!
If you have a resume please email it to info@screentimeclinic.com we would love to see it!
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