Licensure/Internship Supervisor Consent to Attend EMDR Therapy Training
EMDR Training Center, LLC
Email address *
Name of Licensure/Internship Supervisor:
Your answer
Supervisor's License State, Type and #:
Your answer
Name of Potential Training Recipient:
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Month/Year/Location of the training requested:
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:
Supervisor, please type your name to acknowledge your consent here:
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A copy of your responses will be emailed to the address you provided.
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