This form is for non-MUSC employees. MUSC employees should apply using this form.

Personal / Biographic Information

First Name

Middle Initial

Last Name

Full name

Chosen Name

Date of Birth

Contact Information

Address

Country

Address 1

Address 2

City

State

Postal Code

ZIP Code

Phone & Email

Phone Number

Phone (Non-U.S.)

Email Address

Educational / Professional Background

Have you completed your associate or bachelor's degree?

YesNo

Which degree was received?

What year was your degree awarded?

What was your field of study / academic major?

What university / college did you receive your degree?

Exceptions to the Bachelor's Degree Requirement may be made for applicants with 3 or more years of experience in a medical or allied health field.

Please, explain how your prior experience has prepared you for a future in health coaching.

Upload your current resume.

List any current professional licenses and certifications that you have in this section.

Attestation

Documentation of Education

I have completed the requirements for and been awarded the degree(s) indicated below:

An associate's degreeA bachelor's degree or higher

I am aware that I may be asked to present a transcript to verify my completed education.

Documentation of Work Experience

Please summarize your last 4,000 hours of work experience through the completion of the fields below.

Employer

Manager/Supervisor Contact Info

Job Title

Employment Dates

Total hours in this position

Program-Specific Questions

Please describe any healthcare related experience you have that might contribute to your success in this program.

Explain how you believe the Health Coaching Certificate will help you achieve your goals.

Session Selection:

Please acknowledge the statements below as they apply.

I have spoken with the program director or program representative.I am aware that attendance is required to successfully complete the program.I am aware the this program will require a minimum of 6 hours per week.I am aware that I will be required to coordinate my schedule with my triad members in order to participate in 90-minute group coaching sessions each week.

Payment

I would like to pay the $25 Health Coaching Program application fee using my credit card.

Yes

Important!

Upon clicking the button at the end of this form, you will be required to provide your e-signature. You will see the below alert.

After submitting your response, an email with a verification link will be sent to your email address to verify your signature. Click the link in the email to confirm your signature.

Screenshot of alert that says "Incomplete Response - Please click the link in the verification email to complete your signature.

After submitting your signature, you will be redirected to the SC.gov website for secure payment processing. You will receive an email with a receipt of payment from SC.gov.