2019 Application for Online Consultation- Integrating Treatment for Children with 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.
Email address *
Full name- first and last *
Your answer
License AND State *
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. *
Your answer
Please provide a brief description of your current practice (population, ages, history, diagnoses, etc.) *
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 *
I understand that the fee for this group is $100 per group meeting, regardless of attendance *
I understand that there is a minimum four month commitment to this consultation group. After the four month commitment is fulfilled, I understand that I will provide one-month notice before leaving the group. *
I understand that this is not a 'drop in group.' When I sign up for this consultation group, I am making the commitment to attend four groups in a row. I will notify Robyn in advance if I am unable to attend a group. The group fee is charged regardless of attendance. I understand I can participate for longer than four months in a row. Four months is just the minimum commitment. *
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