Sacred Centers

Sacred Centers' Certification Program Application
RequiredRequired Question(s)

Please answer all questions as accurately as possible. Information will be kept confidential among the Sacred Centers staff. Those questions marked with an asterick (*) are better answered in a personal essay.





General Information 


By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Company Name:
Work Phone:
Home Phone:
Email Address:
Address 1:
Address 2:
Postal Code:

Date of Birth




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Past Experience


Please give us your employment history (occupation, dates, etc.)




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What Programs in this curriculum have you already taken? When and where?




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Please tell us in detail why you want to undertake this program and what you intend to do with it when you have finished.*




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Spiritual Practice

Please list your personal spiritual practices, indicating the nature of practice, frequency, and duration (i.e. practice hatha yoga 4x week for one hour for 2-3 years, or practice meditation 2x day for 15 years, or sing, chant, dance, volunteer services, walk in woods, etc.):




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Emergency Contacts

Please list two emergency contacts to be used in case of emergency only. Include name, relationship, and best contact number.




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Reference whom we could speak to upon application. List name and phone number below:







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Health Information

Please list the following in the text box below:


--Current medical conditions.

--Chronic health problems.


--Injuries or surgeries.

--Prescription medications currently taking.

--Drug or alcohol use.

--Current or past psychotherapy.





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Please indicate whether you're interested in certification as a Chakra Teacher or a Chakra Healer (or both).



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Do you have experience with other chakra programs or teachers?





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Please list prerequisite experience in your chosen field, including degrees and/or certifications:




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Formal education and years attended:








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Workshops or other trainings:








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Please tell us in detail why you want to undertake this program and what you intend to do with it when you have finished.









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Certification Program Agreement

Please read carefully and sign by filling in your full name below.


Objectives of Sacred Centers Certification:


1. To further the consciousness, spiritual growth, and healing of all who partake by utilizing the tools and wisdom of the chakra system.

2. To enable students to apply the tools and understanding of the chakra system in their current lives, for personal growth as well as apply when appropriate in work or other venues.

3. To provide peer support and community based on the sharing of this knowledge.

4. To better the world around us by supporting the expansion of individual and collective consciousness through grounded principles that honor body, mind, and spirit.

5. To establish a national network of trained professionals with accountability who have received state of the art chakra training from qualified instructors.


 Certification Criteria:

The courses required for the various specializations are designed to enhance your previous knowledge and prepare you to use this work adequately and effectively. However, it must be stated that mere completion of the courses required does not guarantee certification. While that is our intention, and we sincerely hope that all who go through this program will become qualified, we reserve the right to withhold certification from any who fails to develop the necessary skills and level of personal development to be an apropriate representative of this work. Every attempt will be made to communicate any perceived difficulties as early as possible, and to provide input throughout the program about any deficits that may impede certification in the case that certification is not possible, there is no requirement to complete the training, however, the fees paid for administrative processing and courses completed will not be refunded.






Criteria for certification are based on the following attributes:

Appropriate completion of prerequisites; Completion of courses, reading material, and independent projects; Full comprehension of material and ability to articulate to others; Demonstration of skill, through practice teaching or case seminars; Physical and psychological health; Maturity and ethical conduct; All relevant fees paid in full.


I have read and understand all the above and agree to its conditions (please write your name and date below):







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Questions? 415-234-6338






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