Sleep Systems International
  • Home
  • Company
  • Training
    • Training Application
  • Corporate Consultation
  • Research
  • Links
  • Contact Us
Please print first and complete the following application.  Scan to [email protected].  Thank you.

                                               Sleep Systems International®
                                               
                                                                       

                                                                   Letter of Application

Personal Information

Name:

Current Address:


Permanent Address:


Telephone number:

Cell  number:

Email address:

Age:                 Gender:

Citizen of what country?

Emergency Contact Information Name:

Relationship:

Address:


Phone numbers: Home:                                             Work:

Cell:

Your Educational Institution Name of University:

Address:

Name of program director:

Have you discussed this program with your program director?

Has your program director endorsed your participation in it?

Degree goal: master’s degree __ specialist degree __ doctoral degree __

When do you expect to complete your degree:

Previous training and/or experience in sleep disorders.

 

 
Health

Allergies:                                              

Dietary restrictions:


Chronic medical conditions:

Other health-related information:

English   Are you fluent in English?   Yes     No

Are you knowledgeable and fluent in English medical terminology?     Yes    No

Number of semesters of English classes

            In college:                                 In high school:

Other ways English was acquired:

Estimate your current English language proficiency in

            listening comprehension:        none,  little,  some,  adequate

            speaking:                                 none,  little,  some,  adequate

            reading:                                   none,  little,  some,  adequate

            writing:                                    none,  little,  some,  adequate

Foreign travel List the countries to which you have traveled and for what length of time:

Please state why you are interested in participating in this program.

 

 

 

 

 

 

 

 

 

Please attach a copy of your vitae to this application.

 

 

 

I hereby request to be considered for participation in the Sleep Systems International program . I certify that the information provided above is accurate and complete. 

Signature of Applicant _______________________________  Date _________________

 

This signed Letter of Application and the three signed forms included in Terms and Conditions of Participation in the Sleep Systems International program should be sent to [email protected]. Program participants will be selected in the order applications are received. Applicants will need to submit program payment within two weeks of acceptance. Applicants will be notified via email regarding acceptance. 

Powered by Create your own unique website with customizable templates.