Enrollment Application

The Ministry of Healing Prerequisite Course

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Name: *

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Last

I understand that this online "Ministry of Healing" course is a prerequisite for all the other courses available through the OptiHealth Institute. *

Yes

I have previewed the Course Assignments, and I commit to complete this Course within 6 months. *

Yes

Phone #: *

Email: *

City: *

State/Province: *

Postal Code: *

Month/Year of Birth: *

Gender: *

Male Female

Marital Status: *

Single Married

Current Primary Occupational Field: *

If "Other" above, please specify below: *

In what language(s) are you fluent? *

English Spanish Other

If "Other" above, please specify below: *

The Name of your local Church: *

Do you have experience in church-based health ministry and/or outreach? *

Yes - Extensive Yes - Limited No

Question or Comment (optional): *

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