FSS Application FUNCTIONAL SUPPLEMENT SPECIALIST APPLICATIONTo complete the registration process for the Functional Supplement Specialist course, aka FSS, submit the completed application in full including initials, date, and signature where applicable. For the following, clearly enter your name as you would like it to appear on your certificate along with the address where you would like your certificate mailed.First Name Middle Name Last Name AddressAddress Line 1 Unit [if applicable] City State/Province Zip/Postal Code Country Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwePreferred Phone Email COURSE REQUIREMENTSThis course is for practitioners who have functional ways of testing and/or working with the body to assess and address what will help bring the body towards homeostasis. Please upload a scanned copy of the certification[s] when you email your application. e.g. FNTP [original NTP], RWS, HTMA, FDN, FMP, ND, blood chemistry analysis, applied kinesiology, etc.File Upload Choose File Please describe the training of your uploaded credentials that gives you the skills to functionally assess the body: REGISTRATION Registration Fee: $597 + PayPal processing fees of 3-4.5% depending on country of residence. Registration is on a first come, first served basis and limited to the first 40 applicants. Payment Information: You will receive an invoice to pay the registration fee within two [1] business days of emailing your completed application. Barring the course still has room, participation in the course will be secured when the invoice has been paid. Therefore, it is suggested to pay the invoice as soon as possible to ensure participation.CANCELLATION POLICYRefunds are determined by the following schedule based on the Certified Functional Supplement Specialist course start date: Withdrawal Date: Prior to course start dateRefund: Full refund minus non-refundable $199 deposit Withdrawal Date: Up to 10 business days after course start dateRefund: Full refund minus non-refundable $199 deposit Withdrawal Date: 11+ business days after the course start dateRefund: No RefundPARTICIPANT CONTRACT: Check each box to show your understanding and agreement to the following. I understand that if I need to withdraw from the course I must do so in writing via email to [email protected] I understand the cancellation date will be based on the date of the arrival of my email to [email protected] In the event of dispute over timely notice, the burden of proof rests on me, the applicant. I understand I will be credited a refund based on the above Cancellation Policy. I also understand that I will be issued a full refund if the class is canceled by the Academy of PSC, aka APSC, for any reason. I hereby understand and acknowledge that the APSC reserves the right to approve all applications. Registration will be complete when both this signed, initialed, and dated application has been received and the registration fee has been paid in full. APSC will email written notification to confirm that registration is complete. Course Completion: In order to complete the FSS course and receive CEUs, participants are required to pass the comprehensive scheduled end-of-course exam with a grade of 80% or higher. Be Kind and Courteous: We're all in this together to create a welcoming environment by treating everyone with respect. Respectful questioning to deepen our understanding is welcome, but kindness is required when doing so. Repeated failure to do so will result in removal from the course with no refund. No Religion or Politics. These beliefs are often divisive and therefore disruptive to a learning environment. Anything related to political parties or religion is to remain outside the course. Information regarding policy as it affects the topic of supplements, herbs, and functional practitioners is acceptable. Work within your professional scope of practice: Different practitioners have different scopes of practice. As a practitioner, it is your responsibility to be aware of and work within your professional scope of practice. Responsibility of Actions: It is the responsibility of participants to use what they learn in this course at their own discretion. Therefore, the Instructor of the course and APSC will not be responsible for any injury, medical, or pathological conditions that may occur due to misunderstanding or misuse of the information this course provides. Privacy: Any personal information obtained during this course about other participants is to be held in thestrictest confidence. Any personal information collected during class is strictly for peer to peer contact and is not to be released to outside parties & never to be used for solicitation. Technology: This is an online course and therefore high-speed internet access and the ability to work in an online environment is required. Participants understand it is their responsibility to solicit outside technical support if they experience difficulties accessing the course content due to an issue or limitation of their personal computer, tablet, or internet connection No Promotion of MLM’s or Spam: MLM promotion and irrelevant links are not allowed.DISCLAIMERThe goal of the FSS course is to support the ability of functional practitioners to become knowledgeable about and comfortable with the functional use of supplements in their professional practices. When used appropriately, the information provided in this course can help support health, but does not claim to treat any specific disease or medical condition. This course will not provide medical diagnoses, and no comment or suggestion should be construed as a medical diagnosis or medical advice. Since every human being is unique, specific results cannot be guaranteed from how you, as a practitioner, choose to use the information you learn. Therefore, as a functional practitioner you understand and accept that how you choose to use the information is your responsibility, and at no time in no way will you pursue legal action against the Academy of PSC or its instructor[s] due to potential misuse or misunderstanding of the information provided in this course. Everyone you work with in your professional practice is an individual, and therefore it is your responsibility as a practitioner to use your functional skills to assess and address potential reactions to any supplement you choose to recommend. The information in this course is not a substitute for an appropriate healthcare provider. If you suffer from a medical or pathological condition, it is your responsibility to consult with an appropriate healthcare provider. Laws and regulations regarding certification and licensure requirements differ from state to state and country to country, and occasionally change. It is the responsibility of each practitioner to research the laws in the state or country in which they practice, or intend to practice.Checkbox Field Check here to show your understanding and agreement of the Disclaimer. By signing below, you confirm that you meet the Course Requirements and have read and fully understand the Cancelation Policy, the Participant Contract, and the Disclaimer of this application. You verify you are in complete agreement thereto and do freely and without duress sign and consent to all terms contained herein. You also understand that failure to adhere to the policies in this contract may result in dismissal from the course without refund. I confirm and I agree to the above statement.Signature Sign Here SUBMIT APPLICATION
