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Project NatureConnect Institute of Global Education
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Reconnecting With Nature: Personal Balance Course
Application Form
INSTRUCTIONS: Highlight copy and paste this form into an email to our office.
This form may also be obtained by email from an automailer; simply send the blank email to you get in your email program by clicking here: balanceapplic@aweber.com Complete the form and return/send it to nature@interisland.net
TO: Department of Applied Ecopsychology/Integrated Ecology
I am familiar with the Personal Balance Course description and am applying to enroll in the ten-week online course for the following fee:FEE: Select below A. B. or C.
A. ( ) regular student $290.00
B. ( ) Financial Assistance Student: $290 with financial assistance based on financial need (call 360-378-6313 for information)
C. ( ) Included as one of the seven courses for Level One Certification ($740 total prepaid)
Your name:_________________________________
Email Address:Website URL if applicable:
Postal Address:
City, State, Zip:
Telephone:
Occupation or major interest:
How or where did you hear about the course?
The course starts at the beginning and middle of each month or by
convenient dates for 4 or more participants and a facilitator.My preferred dates to take course:
First Choice Date: Month _______ Day ________ Year________
Second Choice Date: Month _______ Day ________ Year________
Third Choice Date: Month _______ Day ________ Year________
Course Instructions and Readings:
The course fee of $290 includes the two books, Project NatureConnect and The Web of Life Imperative, supplementary email material and all aspects of the guided ten-week Project NatureConnect Personal Balance Course. If you decide to continue on with academic, professional or personal training in this work, you can apply $200 of the course fee to study in the Certification Level One program.
ADDITIONAL PROGRAM PLANS:
( ) YES ( )NO Are you presently interested in continuing on with the Orientation Course Psychological Elements of Global Citizenship course (1 credit optional) ?
( ) YES ( )NO Are you presently interested in the certificate or degree program?
http://www.rockisland.com/~process/( ) YES ( )NO Do you want to obtain transferable credit for this course from Portland State University (PSU)? (It is optionally available for $47.00 above the course cost and may be arranged upon completion of the course.)
NOTE: IGE affiliated university degree program students should ordinarily not apply for Portland State University credit. They automatically obtain credit for this course in their IGE program upon Degree Program enrollment . They do NOT need to apply for PSU credit nor pay extra for it.
INTRODUCTORY STATEMENTS
1. By way of introduction, please share with us in less than 400 words, a good experience that you have had with nature as a child or adult. What do you think, feel or sense about that attractive experience?
2. As a helpful prerequsite for this course please visit the Project NatureConnect web site. Then respond to the paragraph below in the light of the information available on the web site.
Write approximately 350 words (or less) about your background and why you want to take this course. Retain a copy of your statement as you can use it to introduce yourself to your email classmates. You may modify it for that purpose if you choose.
Email all the above and below information to nature@interisland.net and save a copy of it for use in introducing yourself to your classmates on the course
PAYMENT:
A ( ) by Postal Mail: I have accompanied this application with
( ) a check or money order made out to Project NatureConnect
( ) credit card information (below)
and to sent by postal mail to: PNC Balance Course P. O. Box 1605, Friday Harbor, WA 98250
B. ( ) by Email Please charge my credit card $_______________Type of Card ( ) Visa,,,, ( ) MasterCard
Name on Card:___________________________________
First twelve numbers on Card
______ ________ ______ XXXX (do not send last 4 digits in this email) Call
1-360-378-6313 to report the last four digits or the whole number.
Date of Expiration MM/YY (Month/Year) ___/___
Personal identification number on the reverse side of card:_______
Your Postal Address:
City, State, Zip:
C. By FAX ( ) send B information above with the complete Card number to360-378-8325
Signed:
________________________________________
Name appearing here is equivalent to signature
Institute of Global Education
Special NGO consultant to the United Nations Economic and Social Council
Integrated Ecology/Project NatureConnnectDr. Michael J. Cohen, Director
Director: Akamai University Applied Ecopsychology
Faculty: Portland State University Extended StudiesP. O. Box 1605,
Friday Harbor, WA 98250
888-285-4694 (toll free)
360-378-6313
www.ecopsych.com
nature@interisland.net
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,
INSTITUTE OF GLOBAL EDUCATION Special NGO consultant United Nations Economic and Social Council
PROJECT NATURECONNECT
Readily available, online, natural science tools
for the health of person, planet and spiritP.O. Box 1605, Friday Harbor, WA 98250
360-378-6313 <email> www.ecopsych.com
ORGANIC ADVANCED ECOPSYCHOLOGY IN ACTION
The Natural Systems Thinking Process
Dr. Michael J. Cohen, Director
send email
All programs start with the Orientation Course contained in the book
The Web of Life Imperative.
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