Individual Membership Application - International Association of ESD Professionals

Applicant Information

Full Name

Phone Number

Personal Pronouns

She/ Her
He/ Him
They/ Them
Other

Date of Birth

Country of Residence

Where do you currently live?

Email Address

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Qualification Details

ESD Education

Date of Award

Awarding Institution

Transcript/Results

Would you like to add additional Qualification Details?

Yes
No

ESD Education 2

Date of Award 2

Awarding Institution 2

Transcript/Results 2

IAESDP Credentialing Exam

First time
Credential Renewal

Is this the first time you are taking the exam or are you renewing your credentials?

Is there any other information you would like to provide?

Please add any other training and educational highlights that you feel are important for us to consider.

ESD & Teaching Experience

Years of experience teaching

List the languages in which you teach

Do you train/ certify/ offer a certification program for ESD Instructors?

Yes
No

How many Instructors have you trained?

Are you an ESD Mentor?

Yes
No

If yes, what organization(s) do you provide mentorship through?

Do you have Martial Arts or Physical Education Teaching Experience?

Please list all of your relevant Martial Arts and Physical Education teaching experiences here.

Other Education and Mentorship

Please list any other relevant teaching education and experience.

Please indicate any military or law enforcement experience.

Please indicate any Mental Health and Wellness education and experience.

Evidence of Prior Learning

Description of Learning

Work Experience

Training Courses

Supporting Documents

Curriculum Vitae

Click or drag a file to this area to upload.

Please upload your complete resume. This resume should reflect all education, training, and experience that is relevant to the courses that you intend to host on The Idea Bridge.

Certificates and Awards

Click or drag a file to this area to upload.

Upload copies of relevant certificates and awards.

Background Check

Click or drag a file to this area to upload.

If you are a US Resident, you must provide a copy of a Background Check no older than 30-days from the time of your application. You can obtain your background check here: https://www.backgroundreport.com/report/select for just under US$20.00.

Membership Options

Please, select your Membership Tier below.

Choose one:

Please select the pricing Tier that best applies to you. If you are applying for Financial Assistance through Scholarships or Sponsorships, you must complete the Financial Assistance portion of this form.

Choose Renewal Option

Manual Renewal
Automatic Renewal

Stripe Credit Card

Financial Assistance Request

Complete ONLY if you are applying for Financial Assistance. All fields and uploads MUST be completed to process Financial Assistance Requests. If you do not require Financial Assistance, continue to the Agreements Section.

Are you a Student?

Yes
No
Part-time

Current Employer or Educational Institution

List yourself if you are currently self-employed.

Start and End Dates

Please upload any documents necessary to explain your Financial Situation, including proof of Income and Expenses

Click or drag files to this area to upload. You can upload up to 4 files.

Documentation may include paystubs, tax forms, letters from employer or instructors/ educational institutions (on organization letterhead), or a letter from you, on letterheard, certifying your income and expenses.

Agreements

ESD Background to

I certify the following:

I agree to abide by the IAESDP's Confidentiality Policy
I agree to abide by the IAESDP Code of Ethics
I declare that the information I have provided in this application is true and correct to the best of my knowledge.

You must check all three boxes.

Signature

Clear Signature

How did you hear about the IAESDP and The Idea Bridge?