Progressive Counting Consultant Application

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Event(Required)

Name(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Highest Degree Earned(Required)

License Title(Required)

License Number(Required)

Documentation

PC Certification – upload certification certificate(Required)

Accepted file types: pdf, jpg, png, Max. file size: 16 MB.

Completion of PC training at least two years prior to Consultant application – upload of PC training completion certificate(Required)

Accepted file types: pdf, jpg, png, Max. file size: 16 MB.

Letter of Endorsement from a TICTI-accredited PC Consultant(Required)

Accepted file types: pdf, jpg, png, Max. file size: 16 MB.

Copy of your License, Registration or Certification for Independent Mental Health Practice(Required)

Accepted file types: pdf, jpg, png, Max. file size: 16 MB.

Agreements

Select Checkbox to Read and Agree to the Following Statement(Required)

I have provided at least 200 PC sessions with clients

Select Checkbox to Read and Agree to the Following Statement(Required)

I have provided at least 20 hours of PC group consultation and 10 hours of PC individual consultation, under the supervision of an existing PC Consultant – Name of PC Consultant

Name of PC Consultant(Required)

Select Checkbox to Read and Agree to the Following Statement(Required)

I have read and agree to adhere to my profession's Professional/Ethical Code of Conduct, as represented by the relevant professional association (APA, NASW, etc.), regardless of my membership status in that Association

Select Checkbox to Read and Agree to the Following Statement(Required)

I have reviewed and accept the complete TICTI Policies Statement at: www.ticti.org/policies

Select Checkbox to Read and Agree to the Following Statement(Required)

I agree to pay the full certification application fee of $100 promptly after the submission of this application form.

Link to payment - https://www.staging.ticti.org/training/payment/

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