Application For Buteyko Training

You are applying for Level 1 training which is specifically designed for health care professionals to use within the scope of their practice.
Level 1 educators do not have the training to teach patients/clients with serious health problems.
Until you have completed Level 2 training, any patients/clients with health issues must be referred to a Level 2 Educator for breathing retraining.

Date:*

Personal and Contact Information

Name:*
Address:*
Telephone where we can reach you:*
-
E-mail:*
Birthdate:*
Current Occupation:*

Post Secondary Education

Have you had any post-secondary education?*
Have you ever completed a post-secondary course in Anatomy or Physiology?*
Please list degrees and attach copies of each.
If copies of education certificates are not attached, we cannot process your application
Major / Subject
Degree:
Upload Copy/Photo
Additional Education / Training - please attach copies of certificates for all.
´╗┐If copies of education certificates are not attached, we cannot process your application

Subject
Certification
Upload Certificate Copy
Work and Volunteer Experience
Work Experience - please include dates and locations*
Volunteer Experience - please include description and dates*
Coaching / teaching experience - please describe*
Buteyko
How did you hear about Buteyko?*
Why do you want to become a Buteyko educator?*
Do you, a family member or close acquaintance have any respiratory problems?*
Have you taken a Buteyko course for your own health?*
Do you accept that Buteyko can work in conjunction with conventional treatment?*
Criminal Record
Do you have a criminal record?*
Please briefly describe your record:
Do you engage in any activity that could bring the Buteyko Method into disrepute?*
´╗┐Signature
By checking the box below, you are certifying that all information recorded on this application is accurate and true, including the attached documents or any documentation you send separately.*
Please verify you are a human