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Application for Certification Name____________________________________________________________________________ Address___________________________________________________________________________
City, State, and Zip__________________________________________________________________ Phone: Home (
)__________________Work (
)________________ Fax (
)______________ License(s)
- please indicate issuing state: _________________________________________________ ___________________________________________________________________________________________________________________________ Please
submit a typed, detailed description that includes the following: (1) Your training and experience in homeopathy.
Include a detailed list of courses completed, with names of schools
attended, names of your instructors, topics covered, number of credit hours
completed, and degrees and
certificates granted. (2) Your training and experience in health-related
subjects, including documentation of basic anatomy, physiology, pathology
courses - or proof of equivalent background in health sciences. Include relevant
degrees and licenses. Also send documentaton of having taken a CPR course. (3) Your current practice. Include average number of
patients per week, percentage of your practice that involves homeopathy, time
allotted for new patients, types of cases seen. (4) References: List the names, addresses and phone
numbers of three experienced homeopaths who are familiar with your training and
your practice. (5) Any special needs or considerations regarding the
exam. (6) Five chronic cases for review. Cases should be written
formally—including important points in patient interviews, thoughts on case
analysis, rubrics used, remedies considered & comparisons, your reasons for
the remedy chosen, and the patient’s response. Each case should include at
least six months of detailed follow-up. [Those
applying only to take the written exam at this time (the Interim Approach for
"Candidate for Certification" status instead of full certification)
should submit #1, #2, #4, & #5. ] __________________________________________________________________________________ A fee of $350.00
must accompany this application. This
amount includes a NON-REFUNDABLE
application processing fee of $50.00, and
the examination fee of $300.00 which is refundable upon request; (request for a
refund must be received by the CHC no less than six weeks before the upcoming
examination date).
An additional administrative fee of $50.00 must be paid to the CHC by any
candidate who takes the examination, proctored, in a different location than the
CHC office in San Francisco (or other location that the CHC has formally
announced). Professional proctoring
arrangements may be made at local colleges, universities, or libraries—but not
at schools or colleges at which homeopathy is taught. Candidates are also
responsible for all fees required by the proctor. _____
I would like to have the examination proctored & agree to pay the
additional fee to the CHC, as
well as
all other costs involved in the proctoring arrangement. I
acknowledge that I have received and read a copy of the Code of Ethics of the
Council for Homeopathic Certification (CHC).
I agree to follow the principles set forth therein and to commit myself
to the growth of my profession and to my own professional growth. I agree to
abide by the rules and procedures established by the CHC for the certification
process, and further agree to be bound by any decisions made by the board of
directors of the CHC, regarding any and all aspects of the certification it
provides. I
understand that certification by the CHC is not in any way to be represented as
equivalent to licensure as a health care provider.
I agree not to misrepresent the nature of the CHC certification to
anyone, either publicly or privately. Signature_____________________________________________
Date _________________________ __________________________________________________________________________________
Please
send this application, with appropriate documents attached & a check for all
required fees, to: The Council for Homeopathic Certification P.O. Box 460190 San Francisco, CA 94146 (415) 789-7677 You
will be notified of the Council's decision regarding your application within
4 weeks of the application deadline for the scheduled exam.
If your application is approved, you will be eligible to take the exam.
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