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

for Jerusalem or Distance learning program

 

 

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)

                                                                                                                                                                                                   _______

 

Tuition: 18,000 NIS   for program in Jerusalem starting November 30, 2008.      

Scholarships of 6,000 NIS may be available, and can be requested by those in need of one.

Those requiring scholarship assistance are advised to apply early.  

Contributions to the Refuah Institute Scholarship Fund are greatly appreciated and are tax deductible.

 Please consider me for a scholarship: □  

 Certified Professional Coach Diploma - DISTANCE LEARNING PROGRAM

by DVD with ONE-ON-ONE personal telephone coaching & supervision,  Tuition: $5,500  □

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

  

Signed:                                                                                                Date:                          

 

For information call the office: (02) 571-5112

Please send this application to: Fax (02) 587-9557, Email:  office@refuah.net

or mail to: 95 Derech Hahoresh, Jerusalem, 97278, Israel