IEOLC Application/Registration Form Please enable JavaScript in your browser to complete this form.Indigenous EOLC Application/Registration The Inaugaral Indigenous EOLC Program co-hosted by ITM & Strong Earth begins in January 2025 with live zoom sessions on Sat & Sun January 25/26, 12-5pm Sat March 8, 12-5pm Sat & Sun April 12/13, 12-5pm ***Please note, this program is open to Indigenous Peoples only. If interested in our Contemplative End of Life Care program please visit CEOLC If you would like to join our Indigenous EOLC 2025 program, please fill in your details in this Application/Registration Form below. There is a non-refundable $50 application fee. Applications will only be reviewed once the Application fee is paid. The application fee will be deducted from your full tuition payment. **We ask that you only submit an application/registration form when you are certain you would like to join the program. It takes time to review each application, and if you are not ready to join, please wait to submit. *Your application will be reviewed by an Indigenous Advisory Group from Strong Earth Associates. *The Indigenous EOLC program is a global learning opportunity for Indigenous communities, open to both national and international Indigenous Peoples. *This program is only offered in English at this time. *Preference will be given to Indigenous peoples working with Indigenous peoples and communities. ***Upon acceptance you will be forwarded an invoice for the remaining tuition which is due within one week of acceptance. (Spots are not held). *Early applications are recommended, as there are limited spaces in the program. Name *FirstLastList your Indigenous Nation - First Nation, Inuit, Metis, Other *Gender Identity *Pronouns *Phone *Email *Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryPlease tell us about your lived experience as an Indigenous Person *Educational Background *Related Training in End of Life Care (*Previous experience not required) *Employment History (Including if you work for an Indigenous Organization) *Additional Info (that may help us to support you in the training (incl mental/physical conditions) *Personal Reflection of Intent * Please discuss the process and experiences that have led to your interest in the IEOLC Program. *Declaration *AgreedBy checking this box and submitting this application/registration I acknowledge and agree to the following: *All terms, courses, dates, policies are subject to change without notice. *All information filed during this application process become part of your permanent, confidential record. Declaration: I hereby attest that all statements on this application form are true and complete in all respects, and no relevant information has been withheld. I agree and abide by the policies, rules and regulations of the Institute of Traditional Medicine and Strong Earth Associates. *By checking this box I acknowledge and agree to the following: This certificate program does not qualify me to be a Traditional Healer/Elder/Shaman within Indigenous and Non-Indigenous communities.Refund Policies *AgreedBy checking this box and submitting this application/registration I acknowledge and agree to the following Refund Policies & Cancellations For any students/participants who wish to withdraw or cancel enrolment in the program or any classes, formal written notice must be given to the the Institute via email to info@itmworld.org. Students are not eligible for any refunds without formal written notice. Transferring enrolment to a future year is also not possible. *There are no refunds on the application fee. Refunds for withdrawals or cancellations prior to the commencement of the program: A) Full tuition is refunded less a $250 administration fee if notice is received within 30 days of acceptance to the program and at least 120 calendar days before the program start date. B) Subject to A, the full tuition is refunded less 50%, if notice is received less than 120 and more than 90 calendar days before the commencement of the program. C) Subject to A, there are no refunds 90 calendar days before the commencement of the program nor after the program begins. (Note: if you register less than 90 calendar days before the commencement of the program, you will not receive a refund of any amount if you withdraw). Waiver *AgreedBy checking this box and submitting this application/registration I acknowledge and agree to the following: I, the participant release the organizers of the training and their directors, sponsors, employees and agents from any liability for death, disability, injury and property damage. The participant acknowledges the risks involved with participating in the program, and assumes all responsibility, and waives any claims they may have. The participant agrees that they have informed the organizers of any relevant medical (health or mental) concerns that they may have. *I am acknowledging that I have read, understand and agree to the refund and cancellation policies and waiver, and understand and agree that a default in my tuition obligations for this program will be submitted to a third party and may affect my credit rating.Attendance Agreement *AgreedBy checking this box I acknowledge and agree to the following: I, the participant am aware of and agree that to receive a certificate for this training I am responsible for reviewing the materials of the course, completing the assignments and attending all live zoom sessions. If for any reason I miss any of the live sessions (more than one hour of any live session) - I will not be eligible for the certificate. If a live session (more than one hour is missed) I may re-enrol and pay for the missed live session the following year only. If I miss more than one full module live session, re-enrolment and re-payment of the full program is required for issuing of a certificate. There are no exceptions to this policy.Tuition Payment *$1500 +HST (Early Registration by October 15, 2024)$1800 +HST (After October 15, 2024)4 Instalments (monthly) of $480+HST (Available till December 2024)Please specify the payment option of your choice. *Please note due dates. Once accepted to the program, you will receive an invoice to pay your remaining tuition via credit card/debit within one week (unless you have chosen the payment plan). Late payments for the payment plan option will incur a $25 NSF fee for each late payment, per month. The application fee will be deducted from the full tuition amount. Application Fee (Non-Refundable) *Price: $50.00Total *$0.00Application FeePayment Information *CardName on CardSubmit