2025 RISHI's Healer's Art Faculty Development Training Workshop Health Sciences Application

2025 RISHI's Healer’s Art Faculty Development Workshop Health Sciences Application

1. Name and Education History *This question is required.

First Name
Last Name
Preferred Name
Degree(s)
School Attended
Year of Graduation
License #
State of Issue

2. Pronouns

Would you like your pronouns printed on your nametag?

3. School where you will teach The Healer's Art *This question is required.

School Name
Address
City
State, Zip
Country

6. Certification *This question is required.

7. Professional Position *This question is required.

University or School
Academic Title
Professional Role
Years in Position

Professional Position (if more than one held concurrently)

University or School
Academic Title
Professional Role
Years in Position

8. Work Contact Information *This question is required.

Name
Address
City, State, Zip
Country
Work Phone
Work Fax
Work Email

9. Home Contact Information

Address
City, State, Zip
Country
Home Phone
Cell Phone
Home Email

10. Which is your preferred email? *This question is required.

Work
Home

11. How did you hear about The Healer's Art? *This question is required.

12. What courses do you teach at your school? *This question is required.

13. When do you plan to implement The Healer's Art curriculum?

Start Date

14. What is the student audience at your school? *This question is required.

15. What institutional support do you have for this plan?

Administrative
Dean or Dept. Head
Curriculum Committee
Financial Resources

16. What do you anticipate is the greatest obstacle you may encounter in implementing this program?

17. Approximately how many students are in each class at your school? *This question is required.

18. How do you think that The Healer's Art will serve your students, i.e. what are their unmet needs? *This question is required.

19. What draws you personally to teaching this course? Please describe briefly. *This question is required.

20. What experience do you have leading small groups or workshops? Please describe. *This question is required.

21. Please tell us one way that being in the PA profession has enriched your life. *This question is required.

22. In preparation for the on-site training, do you have any health care or dietary needs our staff should know about? Please describe:

23. Is there anything else you would like us to know?

CME credit information for this workshop will be forthcoming.

Financial Information

Registration Fee: Due within 30 days of the acceptance of application.

Health Sciences
$2100 - 4 ½ day Retreat and Training Workshop (Wednesday - Sunday)

Note: Registration fee includes breakfast and lunch, daily. Lodging and evening meals are the responsibility of the participant.

Cancellation & Refund Policy:
60 days or greater to the first day of Workshop = full registration fee refunded, less $100 administrative fee.
59 – 31 days or greater to the first day of Workshop = 50% of registration fee refunded, less $100 administrative fee.
30 days or less prior to the first day of Workshop = forfeit of full registration fee (100%).