Creative Motion Alliance, Inc.
Application for Level II Advanced Certification
in Creative Motion Teaching
LEVEL II INTERNSHIP PROGRAM APPROVAL
(Appendix C)

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:



Internship Program Topic:

Internship Program Goals:


Internship Program Timeline, including completion date


Internship Program Sponsor



Internship Program Printed or Recorded Results




Responsiblities of Applicant




Responsibilities of Sponsor



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.