2010 OC Online Training Course: Letter of Committment

I. LETTER OF COMMITMENT

Contact Information:

_________________________________________________________________________________

Payment Options
a) If paying by check, print and mail the completed form to us at 4220 SW Freeman Street, Portland, OR 97219 USA. Payment must be received prior to the start of the course on Sept. 24, 2010.

b) If paying by credit card, please complete the online registration on our website calendar. A deposit of $295 is required to hold your place.

[  ] I am registering early (by Sept. 8, 2010), and my investment is $795 USD

[  ] I am registering after Sept. 8, 2010, and my investment is $845.

[  ] I am selecting the three payment plan of $295 per month. I have registered online and understand you will charge my credit card the monthly payment on or after Oct. 7, Nov. 7, and Dec. 7, 2010. (Please write MONTHLY in the notes section of your registration form online.)_________________________________________________________________________________

II. AGREEMENT
I, ______________________________________ (please print name), hereby signify my commitment to participate in the OC Online Facilitator Training Course offered by the Human Systems Institute, Inc®, located in Portland, Oregon, for the 2010 Program-year.

By signing this letter, I am signing up for the entire course, and accept responsibility for completing the course materials within the three month period allotted for this training. If I miss a significant portion of this course during that period of time, or fail to complete the online assignments and participate as described in the online classroom, and I have paid my tuition in full, with the director’s permission, I may join a subsequent learning cadre, should this program be offered again and providing space is available, and complete the missed portions of the course without additional tuition charges. I accept the responsibility for making my request to join a later cadre in writing to the director of the Human Systems Institute. This "make up" for an incompleted course offer is valid up to one year after the start of my training program. Failure to pay tuition payments on time may result in my being removed from the program. I understand my participation is important to the success of the other members of the Course, and will do whatever is reasonably within my power to ensure my full participation in the online course I have selected.

The Human Systems Institute, Inc.®, Jane Peterson, Donald Chitwood, their trainers and assistants, reserve the right to accept or reject any person as a participant at any time, and to make changes in the course or classroom software whenever deemed necessary for the comfort, convenience, and safety of the participants, and to cancel a course at any time.
In the rare event a course must be canceled and cannot be rescheduled or a participant is asked to leave during a course, the Human Systems Institute, Inc.®, Jane Peterson or Donald Chitwood or any trainers or assistants supporting the institute shall have no responsibility beyond the refund of moneys paid to it by participants for the portion of the course that was canceled, or for refund of moneys covering the balance remaining of the paid online training modules if the participant is asked to leave before the course is completed. 
In the event that I elect stop my participation in the course after having paid my tuition, the Human Systems Institute, Inc.® is not responsible for refunding my tuition, and may at their discretion, offer to allow me to complete the remaining material with a later cadre providing space is available. I acknowledge that this is an online, self-directed adult learning program and that I am responsible for my progress and performance in this course.
By signing, I agree that neither The Human Systems Institute, Inc.®, Jane Peterson, Donald Chitwood nor any other person acting at the request and on behalf of the Institute shall be liable for any damages, loss or expense occasioned by any act or omission by themselves, their assigns, or any other course participant.

Signature /____________________________________/

Type Name____________________________________

Date_________________
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III. APPLICATION FORM

Full name:

Best phone number to reach you at:

Best email to reach you at:
 
Professional information
1. Please describe your current profession:

 
2. Number of years in this profession:

3. Please give us a brief biography of your professional and other important personal milestones:

 
Background in this field:
1. Please describe your background with constellation work up to this point, specifically, who have been your main teachers, and what trainings have you participated in?  Please give the approximate number of training days and years for each training course you have taken. (We just need an idea of your background - not a detailed dossier.)

2. Please tell us if you are actively facilitating family constellations, approximately how many constellations you facilitate per month, and in what context you do them.

 
3. If you have not received formal training in family constellation work, please describe briefly reading, videos, or other study of constellation work you have done on your own or in study groups that is significant to your development as a facilitator or to your understanding of organizational constellations.

 
4. Please describe any other relevant experience you have as a facilitator you would like us to know about.

 
Learning Goals
1. What I want from this program is:
(a) Professionally:

 
(b) Personally:

 
2. What I bring to this program and to my fellow participants: (give a brief list or description of your areas of expertise, degrees, trainings, relevant experiences …)

 
3. What would be especially helpful for me as a student is...

 
4.  Anything else you would like us to know?

Please email us the completed form (humansystems@comcast.net) as a .rtf, .doc or .docx attachment.

Or you may print out the form, answer in writing and mail to:
OC Online c/o H.S.I.I.
4220 SW Freeman Street
Portland, OR 97219