Application for Integrative Community Therapy Online Training in English
Thank you for applying to receive training and certification in Integrative Community Therapy facilitation. Before you complete this application, please ensure that you meet the following required criteria:
-Must have availability for at least 2 hours a week to perform ICT sessions
-Must be 18 years or older
-Must have experience in community work
-Must have knowledge about local social support networks
-Must have an interest in working as a team, sharing doubts, feelings, difficulties and discoveries
-Must be committed to having time available to participate in online ICT classes and sessions
Please ensure that you meet all of this criteria before submitting your application.
Applications will be reviewed on a rolling basis and are due by January 7th at 11:59PM.
We look forward to hearing from you!
Email address *
Name *
First and last name
Phone number *
Current Address
Organizational affiliation (if applicable)
If you are a mental health professional, are you licensed? If so, what is your license? (You do not have to be a mental health professional in order to receive certification, this is just information for our records.)
Why are you interested in becoming an Integrative Community Therapy facilitator? *
What is your experience working in communities or community outreach? What community networks are you familiar with in your region? *
Certification requires that you form and complete 15 ICT sessions with two other trainees following your completion of Module I. How will you complete this requirement? *
What is your vision for putting this method into action once you have been trained? To what populations do you foresee yourself bringing this model?
The course will cost $300 for each trainee, but financial aid is available. Please provide information as to why financial aid is essential for you to complete the course. (If you do not require financial assistance, respond N/A) *
We ask that you submit your resume to before you submit your application. Have you emailed your resume? *
How did you hear about this training?
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy