Student Graduation Form

学员毕业申请表格

Student Graduation Form

OM SPACE ACADEMY

Student Graduation Form

"*" indicates required fields

毕业生资料 Graduates Personal Information

全名 Full Name per IC / ID*

学员编号 Student ID*

电话号码 Phone Number*

电邮 Email*

地址 Shipping Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

课程 Course*

毕业详情 Graduation Details

毕业仪式 Graduation Ceremony*

出席毕业仪式：出席下一场导师班 5pm
Attend the Graduation Ceremony: Attend the next Mentorship Class at 5pm

选择国家 Select The Country*

马来西亚 Malaysia

新加坡 Singapore

其他 Other

其他国家 Other Country

美国催眠公会会员申请详情 IACT Membership Application

文凭姓名 Name Appear on Certificate*

用户名 Username on Website*

在美国催眠公会网站的用户名 Your preferred username in IACT Website

请上传身份证文件（前后） Photocopy of IC (Front and Back)*

Drop files here or

Accepted file types: jpg, pdf, Max. file size: 50 MB, Max. files: 2.

护照照片 Passport Size Photo*

Drop files here or

Accepted file types: jpg, pdf, Max. file size: 50 MB.

最高学历文凭 Higher Education Certificate (SPM / Diploma / Degree / Master / Phd Certificate)*

Drop files here or

Accepted file types: jpg, pdf, Max. file size: 50 MB, Max. files: 5.

马来西亚专业医师保险申请表格 Professional Indemnity Insurance Application Form*

Drop files here or

Accepted file types: jpg, pdf, Max. file size: 50 MB, Max. files: 5.

毕业同意书 Consent and Agreement

同意书 Agreement*

I hereby confirmed and agreed that:
- I have 100% completed the Learning Portal Online Course
- I have 100% completed the Live Class.
- I have passed the Semester Exam, Final Exam and Ethic Exam.
- My overall grade is exceed 80% or above.
- I have 100% submitted all necessary homework, case study reports and assignments.
- All information provided on this application is true and complete to the fullest extent of my knowledge. If I am accepted IACT may end the relationship immediately if I have made any false statements or material misrepresenations, written or verbal.
- I hereby release and agree to hold harmless from liability the International Association of Counselors and Therapist Incorporated, the officers, employees and volunteers thereof, and/or any other person or organisation that may provide such information.
- I hereby giving the consent to Om Space Academy to submit the International and National Membership and Insurance Application.

是，我同意 Yes, I agree.

签名 Signature*

Submission Date: 01/07/2022

Name

This field is for validation purposes and should be left unchanged.

学员毕业申请表格