Appalachia School of Holistic Herbalism

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Certification Courses Application Form

  • Please take a few minutes to complete our application form online.
  • Fill in as many fields as you can. Fields marked with a red asterisk (*) are required.
  • Your application fee of $50 must be paid separately through Paypal. This payment is secure and you will receive a confirmation and receipt at the end of your transaction. We will notify you of the receipt of your application fee with your application.

IMPORTANT: This application is required for Certification Courses only, NOT Short Workshops!

(If you want to register for a Short Workshop, simply add the Short Workshop of your choice to your shopping cart and proceed through a secure checkout. We will contact you and help take care of the rest!)

Name *

Date of Birth*

Address *

City *


Zip Code*


Email *

Preferred Method of Contact*

Current Occupation/Career Field:

Who May We Contact in Case of Emergency?*

Relationship to You:*

Emergency Contact Phone:*

Certification Course You Are Interested In*

How Do You Plan to Finance Your Tuition and Training Expenses?

Education History

Have you had any prior training or work experience in Plant Energies or Herbalism?

Describe any mental or physical conditions that might affect your participation in the program:

What interests you most about this program?

Where did you hear about us? (Please be specific)

Paypal Payment Name

Upon acceptance, you will be asked to sign a waiver and/or enrollment contract and make a tuition
deposit to secure your spot in class.

Please see our FAQs section or contact us for more details!

We value your privacy. Your personal information is used for application purposes only and will never be shared with a third party. Course applicants and students are automatically added to our private newsletter mailing list. We can remove you from this list at any time upon your request.