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        Renascent College of Intuitive Sciences

Diploma & Certificate Application Form
PLEASE PRINT OUT, FILL IN AND FAX / POST / EMAIL TO RENASCENT

 I hereby apply for the below indicated certificate (s) / Diploma (s). Please fill in date of each course completed & enclose photocopies of certificates achieved for each.

When completed mail to the above address.         Please post to me/ I will pick up

 Complete Correct Spelling of Your Name .......................................................................................

Address to be sent to .................................................................................................................

Phone ........................................      
Email: ...............................................................................

Please note: Top & Bottom of form must be filled in & signed

PROFESSIONAL PRACTITIONER & CERTIFICATION LEVELS

Certificate of Reiki Professional Practitioner

 Reiki 1 Date: .............  Reiki 2 Date: .............  Reiki 3 Date: .............

Reiki Masters Date: .............     If completed prior to 2004 - Reiki Linking Seminar Date: .............

 Certificate of Reiki 1 & 2 Teacher

 Certificate of Reiki Professional Practitioner Date: .............         

Usui Reiki Instructor Training (formerly Advanced) Date: ................         

           

Certificate of Dou jou Reiki Professional Practitioner

 Dou jou Reiki 1 Date: .............  Dou jou Reiki 2 Date: .............  Dou jou Reiki 3 Date: .............

Dou jou Reiki Masters Date: .............

Diploma of Reiki

 Certificate of Reiki Professional Practitioner Date: .............         

Certificate of Dou jou Reiki Professional Practitioner Date: .............         

(*Please note bi yearly Update & Assessment required to maintain status in master classes)

Certificate of Natural Health Sciences 

Reiki 1 Date: ................            BK (TFH) 1 Date: .............    BK 2 Date: .............   BK 3 Date: .............   Crystal Light Balancing Date: ................   Qi Gong 1 Date: .............     Qi Gong 2 Date: .............  

Geomancy Date: ................      Stellar Essences Date: ................         Houses of Life Date: ................

EMF & Chi Products Date: .........  Gem Essence Course Date: ......... Crystal Workshop Date: ................

Diploma of Natural Health Sciences

Certificate of Natural Health Sciences Date: ................      Qi Gong Awakening: Date: ............. 

Qi Gong 3 Date: .............   Qi Gong Masters Date: .............    Reiki 2 Date: .............    

Reiki 3 Date: ........   Reiki Masters Date: ............. If completed prior to 2004 - Reiki Linking Seminar Date: .............      40 hours optional study courses - Please list classes and dates .......................

(*Please note 1 yearly Update required to maintain status in master classes)

Certificate of Basic Kinesiology

Basic Kinesiology 1, 2, 3, (or TFH 1-4) Dates: .............../ .............../ .............../ .............../

60 Hrs optional study courses - Please list classes & Dates: .................................................             .................................................................................................................................

.................................................................................................................................

.................................................................................................................................

(Maximum hours at this level = 10 from healing circle (prior to 2003) or 10 from Qi Gong Cultivation (from 2003 onwards) & 5 hrs from repeats)

  Optional study courses & hrs accredited per course: EMF & Chi products (4), Perceptive Vision (4), Food & Supplement Workshop (4), Practical Anatomy (16), Stellar Essences (8), Houses of Life (8), Crystal Light Balancing (8), Esoteric Gemmology (8), Healing Circle (1.5hrs per class up to 10hrs maximum), Tibetan Energy (4), Basic Anatomy (8), Geomancy - Earth Energies (8), Gem Essence Course (16), Practice Nights (2.5 per eve' - up to 5hrs maximum), Qi Gong Cultivation (1 hr per class - from 2003 onwards up to 10hrs maximum or 4 hours per proficiency level ), Repeats (50% of course hrs - Kinesiology classes = 10 hrs repeats per class, up to 10 hrs maximum), ARC Course (32), Qi Gong 1-3 (16hrs each level), Qi Gong Awakening (4hours) *Interstate / Overseas students can achieve Qi Gong cultivation via instructional DVD's & discourse with Daryll Mitchell.

Certificate of Professional Kinesiology Consultant

Certificate of Basic Kinesiology Consultant Date: ................ 

Qi Gong Kinesiology Date: ................                 Essences in Practice Date: ...............

120 Hrs optional study courses (Including 60 achieved at Certificate of Basic Kinesiology level) - Please list classes & Dates: ....................................             .................................................................................................................................

.................................................................................................................................

.................................................................................................................................

Must Include: Practical Anatomy Date............  .....    An Essence Course Date: ........................

(Maximum hours at this level = 20 from healing circle or 20 from Qi Gong Cultivation & + 10 hrs from repeats)

Certificate of Qi Gong Cultivation Practitioner

Demonstrated proficiency in 6 levels (Please list styles & proficiency below):

Diploma of Qi Gong Cultivation Practitioner

Demonstrated proficiency in 12 levels (Please list styles & proficiency below):

Wuji Level 1  Date: ................  Wuji Level 1-2  Date: ................   Dragon Gate Date: ................   Seven Star Date: ................  Zhineng Date: ................               Guigen Date: ................           Fragrant Gong Date: ................   Tai Chi Date: ................          Medical Date: ................          Dong Yi Gong  Date: ................   Tian Ming Gong Date: ................    Spiritual Date: ................         Shaolin Date: ................   Ba Duan Jin Date: ................

 Certificate of Medical Qi Gong Practitioner Level 1

Medical Qi Gong Level 1 Date: ................          Medical Qi Gong Level 2 Date: ................

Medical Qi Gong Level 3 Date: ................

 Certificate of Medical Qi Gong Practitioner Level 2

Certificate of Medical Qi Gong Level 1 Date: ................   Medical Qi Gong Masters Date: ................

 Diploma of Medical Qi Gong Practitioner

Certificate of Medical Qi Gong Level 1 Date: ................   Medical Qi Gong Masters Date: ................

Qi Gong Kinesiology Date: ................

Certificate of Feng Shui & Geomancy

Feng Shui 1- The Beginning Date: ................     Feng Shui 2- Building On Date: ................

Level 1 Consultancy Date: ................     EMF & Chi Products Date: ................  

Geomancy - Earth Energies Date: ................    Houses of Life - FS Vibrational Medicine Date: ................

2 Home & / or Business reports Date: ................

Professional Feng Shui & Geomancy Consultant

Certificate of Feng Shui & Geomancy Date: ................   Professional Feng Shui Date: ................

Advanced Geomancy - Earth Energies Date: ................ Chinese Astrology Date: ................

Level 2 Consultancy Date: ................     2 Home & / or Business reports Date: ................

Diploma of Feng Shui & Geomancy

Certificate of Professional Feng Shui & Geomancy Consultant Date: ................   

Destiny Analysis & Lopan Date: ................        Tien Ti Masters Date: ................           

Qi Gong 1 Date: .............      Qi Gong 2 Date: .............   Qi Gong 3 Date: .............   

Qi Gong Masters Date: ................                     2 Home & / or Business reports Date: ................

Please Note: Since you commenced studies, diploma /certificate levels may have changed. You can use the current specifications or those that were current in the year you commenced studies.

For further class info - Please refer to the current prospectus (call to have 1 sent) or the website

Thank you for studying with us - we hope you have gained many valuable skills & we look forward to awarding your certificate(s) / Diploma(s) to you.

 

 

I certify that I have completed the above listed courses personally with The International College of Intuitive Sciences & / or Renascent (exemptions may be available for study completed elsewhere - please speak with us personally regarding this matter).           Name: ........................................................Signed:  .........................................

For further class info - Please refer to the current prospectus (call to have 1 sent) or the website

 Thank you for studying with us - we hope you have gained many valuable skills & we look forward to awarding your certificate(s) / Diploma(s) to you.

  Please Note: Since you commenced studies, diploma /certificate levels may have changed. You can use the current specifications or those that were current in the year you commenced studies.

For further class info - Please refer to the current prospectus (call to have 1 sent) or the website

Thank you for studying with us - we hope you have gained many valuable skills & we look forward to awarding your certificate(s) / Diploma(s) to you.

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