Application

PSI Trainer Application

Select Your PSI City(Required)

Personal Information

Name(Required)

Address(Required)

Email(Required)

Mobile Phone(Required)

Best Way to Contact Me:(Required)

Phone

Text

Other

Other Way to Contact Me

I consent to receive communications from PSI Seminars:(Required)

May include phone, email, or social media.

Yes

Gender(Required)

Date of Birth(Required)

Preferred Gender Pronoun

He/Him/His

She/Her/Hers

They/Them/Theirs

Other

Marital Status(Required)

Children and Dependents

Name

Age

Relationship

What is your citizenship status?(Required)

What languages do you speak?(Required)

Ethnicity

White

Hispanic or Latino

Black or African-American

Native American or American Indian

Asian

Pacific Islander

Other

Level of Education(Required)

Grammar School

High School or Equivalent

Vocational/Technical School

Some College

Associate's Degree

Bachelor's Degree

Master's Degree

Doctoral Degree

Professional Degree (MD,JD,etc.)

Degrees, Certifications, and Qualifications

Please list any formal or informal training experiences you have had.

School or Organization

Type of Degree/Certification

Subject or Area of Specialization

Employment Status(Required)

Occupation(Required)

Employment History(Required)

Start with your current or most recent experience, and go back TEN years or to high school. Please include any self-employment, home management, full or part-time, salaried, or volunteer employment.

Company/Organization

Title

Dates Employed

Salary

Reason for Leaving

Community/Volunteer Activities

Trainers must demonstrate leadership, creativity, and initiative in their assignments. Please describe any active community, volunteer, and organizational work you've done. Be as specific as possible. Explain who was helped and how you gained from this experience. List the most recent activity first.

Name of Organization

Involvement/Position(s) Held

Duties, Responsibilities, Achievements

Have you ever served in the armed forces or engaged in intelligence activities for a government organization?(Required)

Yes

Please provide details:(Required)

Include dates and agency or division for whom the work was performed and/or the nature of the connection. If military, include branch, rank, and any service schools attended.

Have you ever been convicted of any offense, including both felonies and misdemeanors, by a civilian or a military court?(Required)

(Do not include traffic violations for which you paid a fine of $50 or less, or any offense that occurred before your eighteenth birthday.)

Yes

Please provide details:(Required)

Include the date and place of each arrest, suit or judgment. Give the nature of the charge or suit, and current status or disposition including any sentence or fine imposed. Provide a complete explanation of the circumstances.

Confidential Health Questionnaire

Medical History

Do you suffer from or have you ever been treated for any of the following:

Personal Health Details

Describe the nature of the problem, treatment, results, and dates for everything checked yes under Medical History. Add any other pertinent medical information including allergies and any current medications or treatments.

Are you currently under the care of a doctor or other practitioner for any reason?(Required)

Yes

Do you have any history of psychiatric disorder, been institutionalized for mental illness within the last 12 months, or undergone treatment by a psychiatrist or psychologist in the last 6 months?(Required)

Yes

Please explain any of the above marked "Yes"(Required)

PSI Activities

Where did you attend the Basic?(Required)

Date Attended Basic(Required)

Date Attended PSI-7 Life Success Course(Required)

Date Attended Leadership Seminar(Required)

Date Attended Principia/Summit/Level Up/Next 10

Date Attended PLD - Pacesetters Leadership Dynamics

Have you staffed before?(Required)

Please check all classes you have staffed.

Not Yet!

PSI Basic Seminar

PSI-7 Life Success Course

PSI Leadership Seminar

PSI Youth Classes

Which staff positions have you held before?

When was the last time you staffed?

How many people have you personally enrolled into the PSI Basic Seminar?(Required)

How have you been contributing to PSI Seminars activities in your city?(Required)

Statement of Purpose

Explain why you wish to be a Trainer for PSI Seminars(Required)

What do you see as the purpose of PSI Seminars?(Required)

What contribution would you make as a PSI Seminar trainer?(Required)

What is your vision for the next 5 years?(Required)

Which PSI Classes are you most interested in facilitating?(Required)

Select all that apply

PSI Basic Seminar

PSI-7 Life Success Course

PSI Leadership Seminar

PLD

PSI Youth Class

What is your level of commitment to becoming a PSI Trainer?(Required)

1-10 Scale....1=I'll Try it Out to See What Happens and 10=100% Committed No Matter What

Signature(Required)

I CERTIFY that all of the statements made in this application are true, correct, and complete to the best of my knowledge, and are made in good faith. I understand that any misinformation may be cause for disqualification or termination.

Name

This field is for validation purposes and should be left unchanged.

Application

PSI Trainer Application

Personal Information

Confidential Health Questionnaire

PSI Activities

Statement of Purpose

PSI SEMINARS

RESOURCES

CLASSES

The Power of Community – Nurturing Growth