If you would like to become a certified instructor through our Jane Jitsu certification program, fill out the form below and a representative from Jane Jitsu will contact you for the next step in the application process.

 
Name *
Name
Date Of Birth *
Date Of Birth
Address *
Address
Which course(s) are you applying for? *
*Check all that apply. The core certification course is required before you can take any other Jane Jitsu course.
Employer's Phone Number *
Employer's Phone Number
Have you ever been convicted of a crime or offense other than a traffic violation, or engaged in any behavior or conduct sufficient to deny certification? *
If yes, please note that you will be asked to provide a full account of each instance.
*