Application - Institute for Menstrual Health

Enrollment for this program has ended

Please join the waitlist for next year’s program which will start in the Fall of 2025!

2024 Women's Hormone Health Certification Application

If you're having issues submitting the form, this could be due to some of your answers being too long for the fields in our system. If this happens to you, don't shorten your answers! Just copy them into an email and send them to hello@nicolejardim.com and we'll make sure your full application gets submitted.

First Name*

Last Name*

Email*

Phone Number*

City, State (US Only), Country*

Where did you hear about this program?*

Please describe your reason for wanting to do this certification program with me?*

List any health-related training or certification programs you've taken or are currently enrolled in? If you are currently enrolled in a training program, when are you scheduled to complete it? This will help us create diverse groups of experience.*

What are your goals for your business in the next 6-12 months? (If you don't yet have a business please let me know that here)*

What would ideal future success look like to you if you were to be accepted into and participate in this program with me?*

Is there anything else you'd like to share with me? (What you're fired up about right now, what lights you up in life, your favorite band?) I want to get to know you 😊*

Enrollment for this program has ended

2024 Women's Hormone Health Certification Application

Get on the waitlist to be the first to know when OUR NEXT enrollment opens!