Training Application

Name:
Address:
City: State: Zip:
Home phone: Work phone: Cell phone:
Email address:
Fill in all that apply below
Cancer Survivor: What type: When diagnosed:
Family Member:
Care Taker:
Medical Provider: Title:

In no more than 5 pages please answer the following questions:

  1. Why do you want to take this training?
  2. How will you use this information when you return home ?
  3. Who will help you implement your training?
  4. What is your commitment to succeed?

Your application can be sent via e-mail to npcoh@spiritone.com The mailing address is Celeste Whitewolf, Native People's Circle of Hope, 9770 S.W. Ventura Ct., Tigard, OR 97223. If you have any questions, please call (503) 245-2253. Thank you for your interest!

Back