Healing Touch Program

Healing Touch Program™ Coordinator Agreement (HTP-002-A)

All Healing Touch Independent Classes

Fill out the form and save a copy on your computer for your records. Attach the form in an email to .

The following is the AGREEMENT for an HTP Independent Workshop/Class. This is a replacement of the Independent Workshops page in the “Guidelines for Coordinating a Healing Touch Workshop”.

Schedule only ONE CLASS per agreement and complete all the information below.

I, (Coordinator) agree to schedule and coordinate instruction for the following class:

Choose one class AND the number of CE hours for the corresponding class

HT Level: 1 2 3 16 hours OR 18 hours

HT Introduction - 1 hour No CEs offered for this class

HT Introduction - 2 hour No CEs offered for this class

HT Introduction - 3 hour 3 hours OR No CEs offered for this

Self Care 8 hours only

Children’s Class No CEs offered for this class

International: Level 4 5 30 hours only

Located in: City: State: Country: Zip Code:

With the following date(s):

Class Marketing Materials (choose one):

Pre approved marketing used

Attached for approval

Class Marketing (choose one):

Post class to HTP website, Energy Magazine and HT Community Newsletter

Do not post class

Requested Instructor(s)

(You may request a particular instructor(s) and they must be in good standing with HTP.)

Instructor Conflict of Interest Status

No OR Yes The above mentioned instructor(s) has had a change in their

Conflict of Interest (COI) Status within the last 30 days.

Note: If Yes, attach a new Instructor COI Disclosure Form.

Coordinator information:

Address:

Email:

Phone Number:

This contract must be accepted and approved by the Healing Touch Program office prior to this class being posted on the web site and listed in Energy Magazine  or the HT Community Newsletter.

Exceptions to this Agreement may be made in writing prior to teaching a Healing Touch class that may fall outside of this agreement. If for any reason the Coordinator cannot, or does not know how to, abide by any of the agreements stated above, he/she may contact the HTP office and seek an individual agreement or addendum that meets the Coordinator’s need to support his or her students. Requests for individual agreements or addendums are to be directed to the HTP office and will be decided on a case-by-case basis. An agreement for accommodation with one instructor/coordinator does not constitute a precedent for agreement with any other instructor/coordinator or for any future class taught by that instructor/coordinator.

The coordinator further accepts and agrees that nothing in this agreement constitutes or grants any right, title, interest, or license in HTP trademarks or materials, or in any copyrighted materials. Signature of this agreement does not constitute an agreement for employment.

This Agreement sets forth the entire agreement between the parties and supersedes any and all prior agreements, written or verbal, with HTP or understandings between the parties pertaining to the subject matter hereof.

All questions to the HTP office are to be directed to

Agreement Terms and Conditions

1. Advertising/Marketing

Pre-approval from the HTP office is required for all class marketing/advertising material. These materials include, but are not limited to, brochures, flyers and advertisements used to solicit students for classes. Instructors working with a local coordinator are responsible for confirming that this requirement is met. The ANCC continuing education statement must be stated in the following exact wording on any marketing materials that list continuing education contact hours, including web sites. Pre-approval is not required for emails sent to local communities for upcoming classes and personal web sites, provided information is consistent with previously approved material.

Required ANCC continuing education statement: Healing Touch Program is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s COA.

Marketing materials sent to HTP will be responded to within five business days after submission. Once approved, materials do not need to be re-submitted unless changes are made to the wording (date, location, and instructor information excepted). Pre-approved brochure templates for HTP Levels 1-3 class promotion are available free of charge on the HTP website: www.healingtouchprogram.com. If these are used with no

changes they do not require approval. A master brochure can be produced by the HTP office by emailing the specific class information to HTP, 4 weeks in advance. This is a free service for HTP sponsored classes. Independent classes are subject to a preparation fee of $25 (fee subject to change).

2. Notification of Classes

Providing all class information, including class name, time, location and continuing education contact hours to the HTP office before class marketing is distributed. Upon notification, classes will be posted to the HTP website, Community Newsletter and Energy Magazine (unless requested otherwise). Accurate contact hour calculation is available on the HTP website.

3. Class Reports

Complete class reports are due within two weeks of class completion. All documents must be sent to the HTP office in one packet via email, fax or envelope. The preferred method is by email to: . If necessary, send by mail to: 15439 Pebble Gate, San Antonio, TX 78232, or by fax to 210-497-8532. This report may be sent by the coordinator or instructor and must include the following in this order:

1. Independent Class Fee Report (Form HTP-I-100) – If paying by check attach it to this form

2. Participant Roster (Form HTP-I-104): to be typed and include all student names, contact information, number of RNs, professional credentials and category of healthcare professional and repeat students if applicable. The continuing education provider requires this information.

3. Confirmation letter to students – One copy with ANCC wording

4. Class marketing materials used – One copy of brochure, flyer, website snapshot, etc.

5. Class Summary Evaluation

6. Participant Class Evaluations (one for every name on the Participant Roster)

7. Coordinator Agreement that was originally sent in to schedule the class

4. Fees

Fees are due within two weeks of class completion.

Deliver payment to HTP for all student and material fees personally or through the instructor. If paying by check please attach check to the Independent Class Fee Report (first page) of the Class Report. Should a class be taught at a college or hospital, payment arrangements for HTP fees should be arranged between HTP and that organization prior to scheduling the class. The current per student fee is posted on the HTP website in the instructor area and is subject to change. This is the fee to teach the copyrighted Healing Touch Program material and for a certificate of competition for the student.

5. Certificates

Obtain and distribute an HTP Certificate of Completion for each student on the Participant Roster stating the correct number of contact hours for each class. Certificate processing time is estimated to be two weeks from receipt of class reports and appropriate student fees. In addition, other certificates may be given by qualified providers of continuing education contact hours, such as hospitals or universities, so long as the HTP certificate is given as well. For special circumstances related to HTP certificates, please contact the HTP office.

I agree to the above terms and conditions.

Date:

Coordinator Name:

By checking here, I am providing my electronic signature approving all the information entered above.

Coordinator Signature (for printed form only): ______________________________________

For Office Use Only Below This Line

Acceptance Standard - Coordinator is in good standing with HTP and Instructor(s) is authorized to teach the Healing Touch Level applied for in this contract and their Conflict of Interest Form is current.