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DSG AFFILIATION INFORMATION FORM
Please Fill Out as Completely as Possible:
Your Name:
Your Name as It Should Appear in Your Listing:
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Street:
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Country:
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Previous Professions Relevant to Your Application:
Educational Degree(s):
For Which Programs Are You Interested in Being Affiliated? (You Must Already Be an Authorized User for The Program.)
SFM I: Next Generation Entrepreneur
1. Institute Where You Were Certified:
2. Institute Owner:
3. Trainer Name(s):
4. Days of Training:
SFM II: Collective Intelligence
1. Institute Where You Were Certified:
2. Institute Owner:
3. Trainer Name(s):
4. Days of Training:
SFM III: Conscious Leadership and Resilience
1. Institute Where You Were Certified:
2. Institute Owner:
3. Trainer Name(s):
4. Days of Training:
Applicant Information
Language Skills:
1. What is your native language?:
2. What other languages do you speak?:
3. How fluent are you in English?
(a) On a scale of 1-10 with 10 being highly fluent, what number corresponds to your
verbal
skills?
(b) On a scale of 1-10 with 10 being highly fluent, what number corresponds to your
written
skills?
Any other information relevant to your request to put on a DSG Affiliated program?
I confirm that the above information is correct to the best of my knowledge.
Date:
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Thank you! We will respond to your application as soon as possible.
If you have any questions, write to us at:
DiltsStrategyGroup@gmail.com