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学员毕业申请表格
Student Graduation Form
OM SPACE ACADEMY
Student Graduation Form
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毕业生资料 Graduates Personal Information
全名 Full Name per IC / ID
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学员编号 Student ID
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课程 Course
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导师班 The Mentorship Program
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
出席毕业仪式 Attend the Graduation Ceremony
文凭邮寄至地址 Deliver the Certificate to my address
选择国家 Select The Country
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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
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用户名 Username on Website
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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)
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护照照片 Passport Size Photo
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最高学历文凭 Higher Education Certificate (SPM / Diploma / Degree / Master / Phd Certificate)
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马来西亚专业医师保险申请表格 Professional Indemnity Insurance Application Form
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毕业同意书 Consent and Agreement
同意书 Agreement
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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
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Submission Date: 01/07/2022
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