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Fill out an Application

*First Name:
Middle Initial:
*Last Name:
*Driver's License #:
*State Issued:
Address (cont.):
*Primary Phone:
Secondary Phone:
*Email Address:
*Confirm your Email Address:
What will you be doing here?:
How many clients or
students do you have?:
Current Employer:
How Long?:
Payment Information

A $25 non-refundable fee must be included with this application.
You will have a chance to choose your method of payment on the next screen.

Privacy Policy
The Metis Center is the sole owner of the information provided to us via this website. We will not sell or rent this information to anyone. We will use your information to run a background and credit check, and we will not share your information with any third party other than as necessary to perform these tasks. The information we collect from you is encrypted and transmitted in a secure way, so as to ensure no third party can intercept this information in transit.
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