Licensure/Internship Supervisor Consent to Attend EMDR Therapy Training
EMDR Training Center, LLC
Name of Licensure/Internship Supervisor:
Supervisor's License State, Type and #:
Name of Potential Training Recipient:
Month/Year/Location of the training requested:
03/2018 Overland Park, KS
04/2018 Chicago, IL
04/2018 St. Louis, MO
09/2018 Springfield, MO
Supervisor, please read the following information on the EMDR Training Center website:
1. The Course Overview
2. The Course Participation Agreement
3. The Course Eligibility
Supervisor, please check the boxes below to acknowledge:
I have read the above EMDR Training Center, LLC website information.
I understand that my supervisee will be practicing EMDR Therapy and related procedures during the training.
I understand that to receive the most benefit from the course my supervisee will need to practice EMDR Therapy with clients during the follow-up consultation period (0-6 months after the training.)
By entering my name below, I give my consent for my supervisee to attend the training.
I acknowledge that my supervisee has completed their Masters Level work and is pursuing Licensure or is a Graduate Student in the Practicum portion of their curriculum.
Supervisor, please type your name to acknowledge your consent here:
A copy of your responses will be emailed to the address you provided.
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