OVERCOMING BARRIERS 2019 TRAINING PROGRAM APPLICATION
Welcome to our immersion training offering! Please take the time to fill out the form below. (All items with an asterisk are required) We will get back to you within a few days to speak to you further about your application.

We are looking for experienced licensed mental health professionals to take part in this unique combination of online coursework and an intensive immersion experience at one of our Family Camp programs.

Camp will run at Common Ground Center in Starksboro, Vermont. www.cgcvt.org
Trainees will be asked to arrive by 3:00 on Sunday, July 7 and may leave late on Saturday, July 13 (or early Sunday, July 14)

Fee for the training is $3500 and includes pre camp webinars, immersion at the program and all meals and accommodations, transportation to and from the Burlington airport in VT and all other expenses while at camp. Transportation to Vermont is not included.

After completing the training you will have a clear understanding of the complexities of this work and of the importance of working with the entire family in the type of intensive psycho-educational programs offered by Overcoming Barriers.

Thank you for your interest!

For questions please email us at overcomingbarriers@gmail.com or call 917-407-1166.

PERSONAL INFORMATION
ALL INFORMATION WILL BE KEPT CONFIDENTIAL
First Name *
Your answer
Last Name *
Your answer
Email address *
Your answer
Phone number *
Please provide the best number (s) to reach you
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Date of Birth *
For example: 01/11/1957
Your answer
Employer Name *
Your answer
Job Title *
Your answer
How did you hear about Overcoming Barriers? *
CREDENTIALS & EXPERIENCE
We would like information on your licensing, years of experience working with high conflict divorce cases and a statement of interest. Do not worry about the criteria. We will review each applicant on his/her own merits and life experience.
What degrees or licenses do you have? *
Please check all that apply
Required
Has your license ever been suspended or revoked? *
If you answered yes to the above question, please elaborate here.
Your answer
Have you ever been the subject of a disciplinary action or censure by a professional organization? *
If you answered yes, please describe the nature of the discipline.
Your answer
How many years experience do you have working with high conflict families? *
Please describe your clinical experience. *
Your answer
Please list other relevant (within the last 5 years) continuing education in the field of forensic and family psychology. *
Your answer
Please tell us about a time in your clinical experience where you had to deal with a particular difficult family in conflict. *
Your answer
Have you ever been convicted of a crime? *
*Please NOTE: A background check will be run upon your acceptance to the program.**
If yes, please describe.
Your answer
STATEMENT OF INTEREST
Please tell us why you are interested in this program. *
Give a short account of your interest. A more detailed statement of interest will need to be emailed to us once you've been contacted by one of our staff.
Your answer
REFERENCES
Please provide two letters of reference. You may have them sent via email to overcomingbarriers@gmail.com with your name in the subject line. Feel free to submit your CV by email as well.

We also need a person (preferably a professional) we can contact by phone. This can be one of your references.

Name of reference to contact *
Your answer
Their Email Address *
Your answer
Their Phone Number *
Your answer
Have you attended another Overcoming Barriers Training? *
For Example: Dallas or William James College online
Your answer
Have you had contact with any member of the Clinical Team? *
Your answer
If so, who?
Your answer
THANK YOU FOR YOUR TIME!
You will receive a confirmation email. (If you do not, please contact us at overcomingbarriers@gmail.com)

We will get back to you shortly to review your application.

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