Enroll in the Academy's Professional
Certification Training Program

Begin by completing this Certification Enrollment Form. If you prefer, you can download a copy by clicking here and return it by FAX to 800-727-2070, US mail or courier to 30765 Pacific Coast Hwy #355, Malibu, CA 9025, or as an email attachment to train@acadgi.com.

Certification Enrollment Form

Please provide the following information and be sure to click the "Submit" button below to send this Certification Enrollment Form to the Academy:

*Today's Date
click on calendar icon -------∆

*First Name

*Last Name

Degree(s)

Occupation

*Primary Email

Secondary Email

*Daytime Phone

*Street Address

*City

*State

*Zip Code

*Country

Professional Licensure If you are licensed by your state to diagnose and treat, please list your license(s) and the state(s) that grant them:

Professional Specialty What particular therapeutic approaches do you utilized and/or what special problems do you treat:

Professional Affiliations List any hospital, academic, institutional, governmental organizations with which you are affiliated:

*Intentions How and in what capacity do you intend to use your training in IGIsm:

AGI's Email List? Use Primary Email Use Secondary Email No Thanks
If you would like to join our Email List to keep posted about new offerings and to get discount coupons for the Imagery Store, please indicate above which email address to use.

Discussion Forum? Use Primary Email Use Secondary Email No Thanks
If you would like to join the AGI Discussion Group which is available to AGI students and graduates to share referrals, chalenging cases, experiences, opinions, questions, and other information of interest to our community, please indicate above which email address to use.

When you have completing this form, click on the "Submit" button below. To clear all fields, click on "Reset."

*Required

After you have submitted this Certification Enrollment Form, make sure you have also prepared the following documents:

(1) Next, complete the Student Contract which you can view online by clicking here and download by clicking here. Please read, sign, and return it, making sure that you agree fully with all the terms and conditions associated with Professional Certification Training. The Student Contract is a formal agreement between you and the Academy and it lists the requirements for Certification, tuition costs, fees, safeguards, protected terms, and other Academy policies. Unfortunately, it cannot be completed online and a written copy must be hand signed and returned to the Academy by FAX, USMail, courier, or email attachment.

(2) Also be sure to submit a copy of your current state license to practice as a health professional, if you have one, or a copy of your student ID card if you are a student pursuing a credential that will lead to a professional license.

(3) If you do not have a professional license, please submit a brief (one to two page) application letter describing your goals in learning IGI^sm; your plans for using it; your access to psychological consultation or supervision, if needed; any previous training or experience you've had in counseling or coaching; and a copy of your CV or resume.

(4) You may return these completed documents to the Academy as email attachments to train@acadgi.com or by FAX (800-727-2070), courier service, or US Mail. All enrollment documents must be received by the Academy before any advanced training materials will be sent.

After preparing these documents, choose the program(s) in which you wish to enroll (if you haven't already done so) by clicking here.

If you have already selected your programs, paid your tuition and fees, and checked out of the shopping cart, click here.

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