Training
Community Service Organizations

The Resilience Advantage™ Qualified Instructor Licensing Program Application

We recommend that you compose your answers to the questions in a word processing program prior to completing the form and then copy and paste them into the form. Once you click the ‘Submit Application’ button or close your browser you will not be able to access a partially completed form so it’s best to complete the entire process when you are ready to submit the form.


No information provided to us will be shared with any third party.
We will never rent, sell, or give out your information.

All fields are required for completion. If a field doesn’t apply, type in N/A.

  1. Which RAQIP training dates do you want to attend?


    Will you be applying for an organizational license?

  1. Yes No

    An independent license includes specific parameters. Are you applying for an independent license?

  1. Yes No

Personal Information


Additional Contact Information (if applicable)


General Information

    Do you prefer to receive HeartMath materials at work or home?

  1. Work Home

  1. How did you hear about HeartMath?

    Do you have an emWave® Desktop?

  1. Yes No

    Do you prefer PC or Mac versions?

  1. PC Mac

    Do you have an emWave2 (handheld)?

  1. Yes No

    Do you have broadband access?

  1. Yes No

  1. What HeartMath products or services have you used?

  1. What professional training have you received?

  1. Describe the trainings you have presented.

  1. Why do you want to become a licensed Resilience Advantage Qualified Instructor?

  1. List your potential audience (Non-Profit Org., Staff, Exec. Board, etc.)

  1. Estimate the number of people you will serve with this program over the next year.

  1. Include a brief summary of professional experience (500 characters max.)

  1. Indicate how you prefer your name to appear on your License certificate (e.g. Janet Connor, Ph.D.)


    Do you have food allergies or restrictions? (e.g. vegetarian, no dairy, fish only, etc.)

  1. Yes No

Reference Contact

Please list contact information for two references:


Reference Contact #1


Reference Contact #2

Submission of this application indicates that you have agreed to the following:

  • For organizational candidate: The license agreement states that you may deliver the Institute of HeartMath’s Resilience Advantage™ workshop and follow up programs to your non-profit or social service agency or to other nonprofit or community based agencies in North America, as per your agreement with your nonprofit. The program may not be delivered to hospitals, for profit businesses or corporations, federal agencies or in public settings in which you charge a fee.

  • For independent candidate: The license agreement states that you may deliver the Institute of HeartMath’s Resilience Advantage™ workshop and follow up programs to non-profit, social service or community-based agencies or local government agencies of 500 or less employees in North America, as per your license agreement. The program may not be delivered to hospitals, for profit businesses or corporations, federal agencies or in public settings in which you charge a fee.

  • I understand the submission of this application form alone does not guarantee acceptance into The Resilience Advantage Licensing Program. I agree that upon completion of my training as an instructor, I will follow the terms and conditions stated in the license agreement.

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