Human Systems Institute™ Letter of Commitment and Training Application1

Constellation Facilitation Learning Program

LETTER OF COMMITMENT

1.0 Agreement Participants.

By signing below, (“Applicant”, pleaseprint your name) I am agreeing to participate in the Constellation Facilitation Learning Program(“CFLP” or the “Program”) described below and offered by The Human Systems Institute, Inc. (“HSII”) for the 2015-2016Program-year, and I agree that my application and participation will be governed by the terms of this agreement.

1.1 Overview of Program Offering.

Program Title: Constellation Facilitation Learning Program

Program Dates:

  • In-Class Sessions
  • Sept 24-27, 2015
  • Jan 21-24, 2016
  • April 21-24, 2016
  • Online Sessions & Video Conferences will be scheduled collaboratively using an online scheduler.

Program Location: Portland, Oregon area

Program Overview:A training program customized to teach basic Systemic Constellation skills, concepts, and practices for application in various professional fields.

1.2 Applicant’s Participation Requirements.

By applying to participate in this Program Offering, I understand my participation is an essentialcontribution to the Program. I agree to participate in the entire program and to the following minimum participation requirements:

  • Attend at least 90 % of themonthly video conferences during the program
  • Participate in the online classroom at least once a week for 90% of the program
  • Attend a minimum of 90% of in-class day sessions
  • Attend all online individual consulting sessions

2.0 Certification, Continuing Education Credits, and Participation in the Program. Should a Certificate of Completion of this Program be offered through HSII, I understand that certification from the Human Systems Institute will be issued only if I successfully complete all of the specified requirements within the time period of this Program.A Certificate of Attendance may be issued on my request for the online and in-class sessions. I am responsible for maintaining an accurate record of my participation through the online classroom. Certification will only be issued if payment is complete.

Certification requirements, if offered, are listed in Attachment 1.

3.0 Deposit & Payment Plan.

3.1 Deposit Requirement.

Applicants must pay a deposit of $335 by the start date of the Program, of which $150 is non-refundable. Deposit is payable either by check payable to the Human Systems Institute, Inc., or by PayPal through , or by any credit card accepted by HSII through their website online registration software, accessible via Should my application not be approved prior to the start of the Program, the Director of HSII may, at his or her sole discretion, return all or a portion of the Applicant’s deposit.

3.2 Payment Options.

By signing this letter, I am applying for the Program described above and agree to pay for all sessions, including any sessions missed during the Program. Failure to pay tuition payments when due may result in my removal from the Program in the director’s sole discretion.

Please select one of the following:

I agree to make a monthly payment of $370USD due on the 5thday of each month throughout the duration of the Program, beginning on October 5, 2015 and ending April 5, 2016. I may negotiate for these monthly payments to occur on a different day of the month at the sole discretion of the Program Director of the Human Systems Institute, Inc. I understand I may pay the balance due for the Program in a single payment at any time prior to the end of the Program if I choose.

Early Bird Discount: I am paying for the Program witha single payment in the amount of $2695 USD on or before August28, 2015.

After August28, 2015: I am paying for the Program witha single payment in the amount of $2995 USD.

All payments are due in US dollars.

4.0 General Program Policies.

4.1 Absences, Making Up Missed Sessions & Changes in Program.

I understand that if I miss a significant portion of an in-class session (either an in-person or virtual class session via video conference or an individual coaching session) of the Program and have paid my tuition in full, if the Program is offered in the following year, subject to space availability, and at the sole discretion of the Program director,I may return in the following year to complete the missed portions of the Program or in-class sessionwithout incurring any additional tuition charges. I understand my participation is important to my own success and to the other members of the Program, and will do whatever is reasonably within my power to ensure my full participation the Program.

The Human Systems Institute, Inc. and its representatives have the sole right to accept or reject any person as a participant at any time, and to make changes in the Program or setting it deems necessary in its sole discretion including for the comfort, convenience, and safety of the participants, and reserves the right to cancel a session at any time.

4.2 Cancellation.

4.2.1 Event Cancellation.

In the rare eventa session is canceled and cannot be rescheduled or a participant is asked to leave during a Program, the sole remedy of the Applicant against Human Systems Institute, Inc. and its officers, directors, shareholders, employees, agents and any trainers or assistants supporting the institute shall be either the refund of money paid by Applicant for the canceled session, or the refund of money covering the balance of remaining paid Sessions if the Applicant is asked to leave before the Program is completed. If a canceled session is rescheduled for that Program-year, and Applicant chooses not to attend, the Applicant is responsible to apply to make up the session in a following year providing space is available and at the discretion of the Program director. Tuition will not be refunded where an Applicant has chosen not to attend a rescheduled session.

Cancellation or requests to reschedule any individual coaching sessions that are part of this program must be made 24 hours in advance notice either by phone call to 001 503 293-0338 or by email to . Cancellations made within less than 24 hours will not be acceptedand the session will not be rescheduled.

4.2.2. Participant Cancellation.

Should an applicant cancel his or her application on or after August 15, 2014 but prior to fourteen (14) business days before the start of the event, all monies received by HSII except the deposit will be refunded.

No refunds will be allowed should an applicant cancel his or her application or decline to participate fourteen (14) business days or less prior to the start of the program.

5.0 Commitment to the Program.

By signing below, the Applicant agrees to all of the terms of this agreement. Applicant further agrees that neither The Human Systems Institute, Inc. nor its officers, directors, shareholders, employees, agents and others acting on behalf of HSII shall be liable for any incident, indirect, special or consequential damages arising from this agreement, from Applicants participation in the Program or for any act or omission of anyone representing HSII or of any other Program participant.

The Applicant has read and understands all of the terms of this agreement, which shall be governed in accordance with the laws of the state of Oregon without regard to its conflicts of law principles. In the event of a dispute between the parties related to this agreement, or to Applicant’s application or participation in any HSII Program, the parties agree that all such disputes shall be resolved by arbitration in Portland, Oregon in accordance with the then effective arbitration rules of (and by filing a claim with) Arbitration Service of Portland, Inc., and judgment upon the arbitral award rendered may be entered in any court having jurisdiction.

Date: m/dd/yyyy
Signature: //
Print Name: / Human Systems Institute Inc.
/Jane Peterson/[tas1]
President

PARTICIPANT INFORMATION

6.0 Contact Information

Full name:

Street Address:

City, State/Province, Postal Code:

Country:

Best phone number to reach you at:

Best email to reach you at:

7.0 Professional background:

7.1 Please describe your current profession:

7.2 Number of years in this profession:

7.3 Please give us a brief biography of your professional and other important personal milestones:

8.0 Your experience and previous training in the area of this Program:

Please describe your involvement with (please check the one applicable to the Program you have selected):

CONSTELLATION WORK: Please describe who you have seen facilitate constellations, other constellation trainings or workshops you have participated in. Please especially tell us how many constellations you personally have done, if any, focused on your own personal issues.

FAMILY OWNED BUSINESS: Do you currently own a family business? If so, please describe your ownership position. What, if anything, have you already done to learn about family-owned business management?

LEADERSHIP TRAINING: Please describe previous experience or training in business and organizational leadership if relevant to your application of constellation work.

9.0 Learning Goals

I would like to incorporate the concepts and practices in this Program into my profession in the following ways:

I am participating in this Program for my own personal evolution with the understanding that this is designed as a professional development Program.

What would be especially helpful in coaching me: (or what I would appreciate….)

10.0 Optional Section for Systemic Constellation Program Participants. Since this training addresses family systems work, it is helpful to the trainer to understand something of your lived experience in your own family and professional systems.

(Circle what applies)

Marital Status

I am currently:

Other

Children

I have 0 biological children of ages:

I have 0 step-children of ages:

I have 0 adopted children of ages:

I have no children:

Other comments you would like the trainers to know about your current family situation or family of origin?

Is there anything else you would like us to know?

Email to or mail the completed Application Form with your signed Letter of Commitment to:

CCLP c/o H.S.I.I.

4220 SW Freeman Street

Portland, OR 97219

[tas1]You can either sign and scan this to the website or add your electronic signature next to the /s/ e.g. “/s/ Jane Peterson”