Tel. (972) 2-571-5112      Email: office@refuah.net

Refuah Institute
Professional Counselor Training Program For Men & Women In Accordance with Torah Hashkafa

Professor Joshua Ritchie, M.D., Dean

Certified Professional Coach Diploma

APPLICATION

 This information allows us to select appropriate students and does not oblige you to take the course

Name                           ___________                                                                                                                                             
(Salutation)    (First   Name) (Last   Name)                               (Degrees)

Address (Home)                               _____                                                                                                                                    
                                                             (Street and Number)                                      (City)                               (Zip Code)

E-mail       Preferred way to receive material:       ______                              

Tel (H)   (W)   Fax   Cell   __________             

Date of Birth    Place of Birth   Marital Status              ______                

Education: (Institution, dates, field of study, Degrees & Certificates)

                                                                                                                                                               __________________     

Experience: (work & volunteer, include dates & supervisors name & way to contact)

                                                                                                                    ________________________________________________

References: (provide name, position/title, and phone or way to contact)

                                                                                                                                                                                                   _______

 Religious Reference: (Rav / Rebbitzen / Congregation / affiliation and contact phone number)

                                                                                                                                                                                                   _______

Certified Professional Coach Diploma - DISTANCE LEARNING PROGRAM

by simultaneous interactive telephone Conference and or by internet video conferencing .

Tuition: $5,900 

You may attach your résumé or C.V.   A photo of yourself is helpful.

Signed: Date:

For information call the office: International 646-3959-613, NY 718-438-4466, Israel (972) 2 571-5112

Please send this application to: Fax 347-493-3554, Email:  refuahoffice@gmail.com

or mail to: NY office, Esti Gluck, 1327 52^nd St, Brooklyn, NY, 11219

REFUAH INSTITUTE     Tel. (972) 2-571-5112   Fax (972) 2-587-9557    Email: refuahoffice@gmail.com