Creative Motion Alliance, Inc
Application for Level III Professional Certification
in Creative Motion Teaching
ACTIVITIES APPROVAL
(Appendix H)

To apply you may complete the online form below, or download and complete the application form and mail to chair of the Certification Committee.


Date :

NAME
Salutation: Mr. - - Mrs. - - Ms. - - Dr.
First : Last:
Address and Contact Info
Mailing Address - Street Address:
City / Town : State / Province : Zip
Phone:
Other Phone:
E-mail 1:
E-mail 2:




Describe your proposed Level III activity #1


Describe the subject of your Creative Motion Analysis



Describe your proposed Level III activity #2



Describe your proposed Level III activity #3



If you wish to retain a copy of this form for your own records, please print this prior to pressing the Submit button.

This application will be reviewed by the Creative Motion Alliance's Certification Committee.
You will be informed of the committee's decision in a timely manner.