First name:

Last name:

Email:

Blog, website or other online address: (optional)

Street address:

City:

State, province or region:

Country:

ZIP or postal code:

Phone:

Date of Birth:

Gender:

What is your native language? Do you speak any other language?

Which module are you signing up for?

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How did you hear about Time to Teach A Course in Miracles?

What is your purpose for doing the Time to Teach A Course in Miracles distance learning?

What do you expect to get out of it?

Tell us something more about yourself...

Are you...

How long have you practiced and or taught A Course in Miracles?

Do you have any experience writing?

Do you have any experience with formal teaching or public speaking?

Do you have any experience healing or praying?

Do you have experience with publishing or marketing?

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Please list all days and times you have open during the week.
(This will help us schedule the weekly classes and the One on One and Conference calls. The duration of each class will vary from 1 to 1½ hours depending on the number of participants).

What time zone are you in?

or other:

How good is your English in speech and writing?

How are you connected to the internet?

Do you have daily access to the internet?

Is the following software installed on your computer?

Do you own any of the following books?

- If yes, what version?

- If yes, what version?

Are you familiar with the 12 steps of Alcoholics Anonymous or related recovery programs?

Are you currently taking drugs, smoking cigarettes, drinking alcohol, otherwise sedating yourself (Medication, sex, food.)? Please explain:

Are you willing to stop this for the duration of this distance learning course?

What platform do you use?