Certification Application – AiRM – Artificial Intimacy Recovery

AIRM™ Certification Application Form

Apply for your Artificial Intimacy Recovery Model™ certification. Choose between initial certification or recertification based on your current status.

Initial Certification Application

Complete your first AIRM™ certification. All fields are required.

Personal Information

First Name

Last Name

Email Address

Phone Number

Professional License Information

License Number

License Type

License State

License Expiry Date

Training Certificates

Level 1 CE Certificate

Level 2 CE Certificate

Supervision Verification

Verification of Supervision Hours

Supervisor Information

*Certification Fee - $150 (Payment will be processed after application review. You will receive an invoice via email)

Application Review Process

Applications will be reviewed within 5-7 business days. You will be notified via email from the AIRM team when your certification has been approved. Please ensure your email address is correct and check your spam folder for communications.

Recertification Application

Renew your AIRM™ certification. Valid for 2 years from approval date.

Personal Information

First Name

Last Name

Email Address

Phone Number

Current License Information

License Number

License Expiry Date

Continuing Education Requirements

Upload all CE certificates (8 hours minimum). Multiple files accepted. Current certification must not be expired

*Recertification Fee - $150 (Payment will be processed after application review. Certification valid for 2 years.)