THE AMERICAN COLLEGE OF HYPNOTHERAPY

APPLICATION FOR RE-CERTIFICATION

 

Application for RE-Certification for: _____ Certified Hypnotist _____ Certified Clinical Hypnotherapist

 

Name:____________________________________________________________________ Date :_____________

Mailing Address:______________________________________________________________________________

City:____________________________________ State:_____________ Zip:____________________________

Phone:__________________________________ Fax:________________________________________________

Email Address:________________________________________________________________________________

 

 Date of last Certification: ______________________________________________________________


Full Name at time of last Certification (if changed): _________________________________________


Number of hours of practice as a hypnotist or clinical hypnotherapist within a four- year period from this date of
application:________________


Employer or Place of Practice: _________________________________________________________


City: ________________________________ State:_____________________ Zip:________________


Name of Supervisor (if applicable):__________________________________________________________________


Candidates must have practiced for at least 200 hours of practice within the three year period of active certification. Candidates for recertification must submit a copy of their job description, or a letter signed by a supervisor (if applicable), or other evidence of practice as a hypnotist or clinical hypnotherapist.


Number of hours (contact hours) of continuing education since last date of Certification:
Total contact hours: ____________________________________


Applicants for recertification status by Continuing Education MUST submit copies of all continuing education certificates, and/or college transcripts, verifying completion of the minimum required hours. 


Criteria for Recertification by Continuing Education Hours


1. Candidates must have acquired evidence of 50 contact hours (1 contact hour = 50 minutes of study/lecture/learning activity. Contact hours must have been acquired within the four year period of active certification by the American College of Hypnotherapy. College courses are acceptable. For calculation purposes, one semester hour of college credit is equivalent to 15 contact hours of continuing education.
2. Continuing Education contact hours must be acquired accordingly: 50% of hours must be directly related to hypnosis and/or clinical hypnotherapy; and 50% of hours may be related to similar subject matter, including psychology, counseling, stress management, meditation, spiritual education, etc.3. Candidates must have practiced for at least 200 hours of practice within the four year period of active certification. 4. Applicants must submit copies of continuing education hour certificates or verifications. Copies are acceptable. If originals are sent, they are not returned.
Applicants must submit to the American College of Hypnotherapy photocopies of all education certificates or transcripts, verifying attendance and completion of the educational programs, seminars, courses, etc. The ACH reserves the right to contact any providers of such programs and verify completion/attendance by the applicant.

The completed application for recertification, along with copies of continuing education certificates or college transcripts should be sent to:

American College of Hypnotherapy
2400 Niles-Cortland Road, S.E., Suite # 4
Warren, Ohio  44484

 

Method of Payment- Application fee for 4 year term of certification is $ 200.00

Payable to: AIHCP

_____ Check

_____ Money Order

_____ Credit Card _____ Visa _____ MC ____AMX

 

Card Number:____________________________________________________

Expiration:_______________________________________________________

 

Name on Card:_____________________________________________________

Signature:__________________________________________________________

I, the undersigned, verify that this application is complete, and to the best of my knowledge, all information provided is factual and true. I understand that failure to provided the needed information and required documentation could likely lead to delays in the processing of this application. I further understand that if any information supplied on this application is false, that I will be denied consideration for certification. I further understand that if at any time it is discovered that I have made false or untrue statements on this application, or misrepresented myself, or have provided fraudulent documentation to the ACH, that the ACH may rescind my certification and fellowship status.

Agreed:

__________________________________________         ________________________

Signature                                                                               Date