Seed of Faith Award Nomination Form

Section 1 — Applicant Information

Organization Name:

Country / Address:

Website:

Primary Contact Person / Title:

Email / Phone:

Section 2 — Organization Type (check one)

Verification Category

KAMTOUR Verified Healthcare Provider™ KAMTOUR Verified Healthcare Facilitator™ KAMTOUR Verified Wellness Hospitality Partner™

Section 3 — Verification Level Sought

Full Verification Provisional Verification Affiliate Verification

Section 4 — Ownership and Licensure

Business Registration Number:

National/State License Numbers:

Year Established:

Section 5 — Self-Assessment Summary (Yes/No + Comments)

Yes No

Patient Safety Policies in Place — Comments:

Yes No

Bilingual (Korean/English) Communication — Comments:

Yes No

Transparent Pricing Disclosure — Comments:

Yes No

HIPAA/PIPA Data Protection Compliance — Comments:

Yes No

Facility Photos or Virtual Tour Attached — Comments:

Yes No

Emergency Response & Referral Protocols — Comments:

Yes No

Post-Treatment Follow-Up / Telehealth Support — Comments:

Section 6 — Required Attachments

Business license
Facility photos or virtual tour link
Key staff credentials
Insurance certificate

Acknowledgment

I hereby certify that all information provided is true and accurate. I understand that KAMTOUR Verified™ is a voluntary, private-sector designation and does not constitute a governmental license, endorsement, or guarantee of outcomes. I agree to abide by the standards and audit requirements set forth by the Korea–America MedTour Association, Ltd. (KAMTOUR).

KAMTOUR Verified™ is valid for three (3) years from date of approval and may be renewed upon re-evaluation.

Applicant’s Authorized Representative (Print Name):

Signature (Click here to sign when converted to PDF):

Date: