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:
Your answer
Month/Year/Location of the training requested:
RELEVANT INFORMATION
Supervisor, please read the following information on the EMDR Training Center website:
1. The Course Overview https://emdrtrainingcenter.com/?page_id=2069
2. The Course Participation Agreement https://emdrtrainingcenter.com/?page_id=3504
3. The Course Eligibility https://emdrtrainingcenter.com/?page_id=7
Supervisor, please check the boxes below to acknowledge:
Supervisor, please type your name to acknowledge your consent here:
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of EMDR Training Center. Report Abuse - Terms of Service - Additional Terms