Sexual Health Alliance Sex Therapy Certification Application
Email address *
Name *
Address *
Birthdate *
MM
/
DD
/
YYYY
Phone Number *
Email *
Please send the following information to SHAcertifications@gmail.com **Your application will not be reviewed until you email the following in ONE email. *
Required
Please write your personal statement in the section below. Describe your intent and reason to enroll in this program. Note which city or cities you would attend (ex. Austin, Denver, LA etc) (500 words max) *
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