Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mobile *

Country

(###)

###

####

Have you completed a class cycle in full as a Mentor before? *

Yes

No

Have you ever been dismissed as a Mentor? *

Yes

No

Select Cohort *

Please select which cohort you are applying to Mentor for:

February Cohort

May Cohort

September Cohort

Workshop Preferences *

At NTA AU/NZ honouring each person’s bio-individuality is our most important philosophy, and as such we respect everyone’s right to health privacy and their own unique needs. As an organisation we are committed to inclusivity, honouring human rights, and respecting each human sovereign being. As such we now provide the following options regarding workshop attendance: Workshops are now run in a hybrid format, with the following options available regarding attendance: • In person (main centers) - this is subject to numbers, personal health requirement preferences and current travel/ health mandate restrictions. • Regional small groups - this is subject to localised support and personal health requirement preferences. • Virtual groups - no travel requirement, students will all require a practice body (i.e. family member/friend) for all days of workshops. For our team to establish the workshop formats for the cohort you are applying for, please indicate your preference for your own workshop attendance. Note: Workshop attendance is still mandatory regardless of which format you partake in.

In Person (Main Centres)

Regional Small Groups

Virtual

Mentor Benefits Selection *

A Mentor is a volunteer position, however accepted applicants who attend all three workshops, the practice sessions and complete all task requirements, will receive Mentor benefits as payment after the class cycle is completed. Mentor's who do not complete all requirements may be eligible for partial benefits. Please select between one of the two benefit pathways. Option 1: Business Development Pathway 1 year access to our brand new FNTP Mentor Business Portal which includes: • Free downloadable business and clinical pdf library specifically designed for FNTP’s • Monthly Clinical & Business Development Mastermind Calls • Free Marketing and Event Planning Resources • Affiliate Resources • “Done 4 U” program packages and e-course • Custom built energetic test kit special 60% Mentor discount Option 2: Personal Development Benefits Pathway • 12 x one hour self testing coaching sessions for personal health and development. Sessions are held monthly and run for 12 consecutive months. • Discounts on cross referral services (Somatic therapy, Breathwork, PsychK, Theta, yoga, sound therapy and functional labs). • Free downloadable personal development pdf library specifically designed for FNTP’s • Custom built energetic test kits special 60% Mentor discount. In addition, both packages include: • Free Subscription to Nutri-Q for one year ($180 USD) • One year NTA Membership via the practitioner portal. Which includes access to the latest curriculum updates (value S14,444 AUD), plus educational resources and more. • Discount to the value of $50 AUD for any of the currently offered Advanced Postgrad Trainings available for one year after completion of CM year. •Discount of 50% off RRP of any of the Advanced Energetic Test Kits on offer by NTA AUNZ • 24 CEU points

Business Development Pathway

Personal Development Pathway

Mentor Code of Conduct *

Mentors are expected to adhere to the following standards of conduct in order to maintain the integrity of NTA AU/NZ and the FNTP program, provide an effective educational environment for all classroom participants, and ensure student safety. Please carefully review each criterion below and sign at the bottom of this Mentor Code of Conduct section to indicate you have read and understood each item. •The primary role of Mentors is to help students learn the curriculum, Client Consultation process and the Functional Clinical Assessment (FCA). • Mentors shall direct student questions, concerns, or frustrations to Lead Instructors when appropriate. • Mentors must always keep all information shared during Client-Practitioner exercises confidential. • Mentors must always ask for permission to touch before demonstrating FCA points. • Mentors should limit questions to Lead Instructors during class to prioritize student learning time. • Mentors must review all relevant FCA points, readings, videos, FCA quizzes, webinars, and audibles etc. prior to each workshop. • Mentors shall be available at least 30 minutes before the scheduled start of the workshop , as per workshop schedule, for a Mentor briefing (virtual or in person). • Mentors shall commit to the same workshop attendance policy as students. • If unable to attend a workshop, Mentors shall inform the Lead Instructor minimum of three weeks prior to the workshop date. Unavailability notified within the three week period, will require the Mentor to arrange a swap/cover with another mentor. • Mentors must attend all scheduled workshop days, complete all Mentor tasks in the learning platform, and attend/watch the recording of all class calls. • Mentors must complete the Client Consultation peer reviews as directed by the Lead Instructor • Mentors are prohibited from teaching or discussing clinical skills outside of the FNTP Scope of Practice. • Mentors are prohibited from promoting any products or services to students. • Mentors are prohibited from sharing or selling student contact information to any outside parties. • Mentors should sit among students during class and FCA practice to provide direct assistance. • Mentors should be on task at all times during workshops and practice sessions, not on their phones/chatting, and should have their video on if attending virtually. • Mentors performance will be reviewed by Instruction Teams and students after each workshop. • In the rare event a conflict arises, the Lead Instructor has complete authority and discretion to dismiss a Mentor. By signing below, I acknowledge that I have read and fully understand the expectations listed above, agree to adhere to the codes of conduct set forth by NTA AU/NZ. I also understand that failure to follow this code may result in the dismissal from being a Mentor for the FNTP program.

First Name

Last Name