2019 Application for Online Consultation- Play Therapists & Complex Trauma
Thank you for applying to the online consultation group! I'll review your completed application and if it seems as though the group is a good fit for your needs and experiences, I'll send you confirmation paperwork, including payment.
* Required
Email address
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Your email
Full name- first and last
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Your answer
License AND State
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Your answer
If not independently licensed, please include your supervisor's name
Your answer
Your supervisor's phone number (or skip)
Your answer
Please provide a brief description of your background and experiences.
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Your answer
Please provide a brief description of your current practice (population, ages, history, diagnoses, etc.)
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Your answer
I understand this group meets once a month on Wednesdays from 12 to 2pm CENTRAL TIME. If I am not in central time zone, I will make the appropriate time zone adjustment
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Yes
No
I understand that the fee for this group is $100 per group meeting, regardless of attendance
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Yes
No
I understand that there is a minimum four month commitment to this consultation group. After the four month commitment is fulfilled, I can choose to continue in the group. I understand that I will provide one-month notice before leaving the group.
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Yes
No
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