Application-Closed If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Application Deadline: July 30 Please note: In addition to this application, applicants must also submit all supplementary materials by August 5, as well as a nonrefundable $150 application processing fee. Dates for Training: 2019: September 27-29; December 6-8 2020: March 20-22; June 5-7 Contact Information First Name * Last Name * Email * Phone Skype Username Street Address * Apt. 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However, candidates with less experience will be considered. Institution where degree obtained: * Primary Clinical Discipline: * Art Therapist Counselor Dance/Movement Therapist Drama Therapist Expressive Arts Therapist Music Therapist Nurse Pastoral Counselor Play Therapist Poetry Therapist Psychiatrist Psychodramatist Psychologist Social Worker Other (Please specify below) If "Other" selected, please specify: Professional Credentials (Certifications/Registrations/Licensure): Additional Training/Credentials (e.g., EMDR, SE, DBT): Interest in This Program How did you hear about this training? * Friend or colleague "Our Clients, Ourselves" workshop (June 2014) Other conference event Other source What about this certificate program is of particular interest to you (e.g., faculty, location, topics covered)? * Please provide a brief description of your clinical background with trauma survivors, including the populations you have worked with: * Please describe your special interests regarding working with traumatized populations: * Please list some of the challenges you experience in your work with traumatized populations: * Is there anything else you want us to know about you or your training needs?