Herbal Clinical Week Student Application Form
All herbal medicine, engineering or provider team students must fill out this application to be considered for the 5-day clinical training week in the Navajo Nation, AZ during July 10 - 14th, 20107. If accepted, all students have advance team preparatory work that will precede the trip.
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CLINICAL HERBAL INTENSIVE WEEK: NAVAJO NATION 2017
Student Name *
Email *
Contact Phone Number *
Which team do you want to participate on? *
Herbal Medicine Team (list the courses you have taken here)
Off Grid Engineering Team (list the courses you have taken)
Provider Team (list experience or courses you have taken)
Have you taken the Core Basic course? *
What other experience do you have that might be helpful in a clinical week like this?
Please list any pre-existing health condition we should be aware of .
Herbalist Conduct Code: This must be agreed to in order to attend this clinical intensive week.  http://www.herbalmedics.university/courses/herbal-clinician-program/herbal-clinical-week-intensives/herbalist-behavioral-code/ *
This is the date you are submitting the application: *
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