Equivalencyinterview Checklist - Level 5

EquivalencyInterview Checklist - Level 5

Student Name: (Please Print)

Last ______First ______MI ____

Address ______

City ______State/Province ______

Zip/Postal Code ______Country ______

Phone ______Email ______

Student has completed Level 1:  HTP or Other, Level 1 Transfer Date: ______

Student has completed Level 2:  HTP or Other, Level 2 Transfer Date: ______

Student has completed Level 3:  HTP or Other, Level 3 Transfer Date: ______

Student has completed Level 4:  HTP or Other, Level 4 Transfer Date: ______

Student has completed Level 5 through: ______. Class Dates: ______

HTCertificate of Course Completion date: ______

The following must be met to receive HTP Level 5 Equivalency

Professional Profile Notebook

____ The student provideda Professional Profile Notebook (PPN), via a digital file such as a

.pdf or physical PPN.

____Discussion included a review of the PPN, student’s HT practice and experience creating

the PPN.

Client Sessions and Intake Interviews

____ The student completed documentation of 100 client sessions and 15 intake interviews

and provide 3 client sessions with intake interviews on HTP required forms.

____During the interview the documentation and clinical experience of these sessions and

interviews were discussed.

____Instructor reviewed at least 3 client sessions with Intakes, which reflected a variety of

health issues and HT interventions.

____Student demonstrated the Healing Touch 10 stepsequence on required HTP forms.

The student was able to adequately discuss:

____Ten Self-care modalities from four perspectives.

1) self care

2) building referral group

3) professional standards and practitioner-client relationship,

4) value of experiencing first hand ten holistic modalities.

____ Networking practices

____Community service project(s).

____The Case Study process including appropriate applications of HT

interventions/sequences.

____The certification process, differences between Level 5 homework and certification

application and the certification packet as found on the certificationwebsite.

____The history of Healing Touch, the HTP organizational chart, ANCCaccreditation,

affiliations such as HTWF, HTPA and student/practitioner resources.

Student submitted the following and these documents were reviewed and discussed:

____ A one page reflective review of ethics text by Dorothea Hover-Kramer, Creating Healing

Relationships.

____ A 1-2 page resume according to HTP Level 5 guidelines (see HTP Level 4/5 notebook).

____ A mentorship report and verified six months of mentorship experience with a HTCP or CHTP.

There was discussion about the mentorship report and experience.

Mentorship meet criteria at this time

Student should continue mentorship from current time through submission of the

certification application.

The Student:

Has demonstrated she/he has the knowledge and practice base of Level 5 course work

necessary to earn a HTP Certificate of Course Completion and move forward toward

becoming a Healing Touch Certified Practitioner.

 Needs further development or to complete further requirements as described below before

receiving their certificate of Course Completion

Additional Requirements - Level 5

Please outline any additional developmental requirements needed by the student before the transfer may be completed. This sheet should be copied and given to the student for their reference. The original should be sent to HTP with the above checklist once the student has completed the requirements, a second interview has transpired and the instructor has signed indicating the student may receive a Certificate of Course Completion.

Additional action item(s) required for Level 5Equivalency completion:

Date of 2ndInterview: ______

The student:

 Has now demonstrated s/he has the knowledge base of Level 5 course work necessary to

receive an HTP Certificate of Course Completion.

 Instructor recommends that the student re-take Level 5 through HTP.

Instructor Name: (Please Print) ______

Instructor Signature ______Date ______

Mail this signed form and copies of the students HT class completion certificates to:

HTP 15439 Pebble Gate, San Antonio, TX 78232 or fax to 210-497-8532 or email to

(for office use)Date Transfer Packet received: ______

Level 5 Certificate mailed date: ______Certificate of Course Completion mailed date: ______