Basic Training in Selective Mutism Registration April 17, 2021
Provided by Simply Psychology, Dr. Alicia Goodman, PhD., NCSP
Perfect for Parents & Teachers/School Professionals
This virtual training will be held on Saturday, April 17, 2021 from 9:00 AM - 1:00 PM. The cost is $200 per family and $50 for teachers/school professionals. Each paid registration will receive 1 session link which will be provided by email 48 hours prior to training.
Upon completion of this form, you will receive an invoice from Simply Psychology, LLC for your registration which will be due upon receipt. Spots are limited and will only be confirmed with your paid registration. Documentation of attendance for CEs provided upon request.
We welcome school districts/educational groups to contact us for private group training options. For this or any other questions, please call our office at 602-428-2838 or email us at
. You can also visit our website at
I am a...
Are there any specific questions you want answered at the training?
The cost for the training is $200 per family and $50 per teacher/school professional. Payment is due at the time of registration. Please check all that apply.
I would like to register for one family.
I would like to register for one teacher/school professional.
Other, please contact me.
Current email address for invoicing.
Current contact number for questions pertaining to your registration.
Family email address for Zoom link.
If you are a teacher/school professional, do you want a certification of completion?
Teacher/School Professional email address for Zoom link & Certificate of Completion. (If you are a parent registering your child's teacher/school professional, their email can be provided at a later date.)
How did you hear about this training?
Never submit passwords through Google Forms.
This form was created inside of Simply Psychology LLC.