Fellowship Application

Please enable JavaScript in your browser to complete this form.

Please provide the following information:

Personal Information

Company Information


Home Address

Please indicate below if you do NOT wish for your information to be listed in the online Fellows Directory


Please upload the following documents:

  1. Evidence of successful use of hypnosis in clinical practice or research.
  2. Copies of papers relating to hypnosis published by you in recognized professional journals
  3. Documentation of your teaching of organized courses in hypnosis in recognized professional schools and/or professional societies.
  4. Evidence of participation as an officer or committee member of ASCH, or other organizational utilization of hypnosis (publicity, publications, national or international recognition, organizing component societies, etc.)
Click or drag files to this area to upload. You can upload up to 25 files.
Allowed file types: . png,. gif,.jpg,.doc,.docx,.xls,.ppt,.pdf

Referral Information

Please list three (3) persons, other than persons who nominated you, who may be contacted for a confidential evaluation of your ethical and professional status.


This application and the requested material are agreed to be dealt with as completely confidential in nature by the ASCH National Office, the appropriate reviewing parties, and the candidate. I attest to the following: