Intensives 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

Copy of Your Certification in Intensive Trauma-Focused Therapy(Required)

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

Letter of Endorsement from a TICTI-accredited Intensive 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 intensives to at least 20 clients, for a total of at least 100 full days.

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

I have provided at least 20 hours of PC or EMDR group consultation and 10 hours of Intensive individual consultation, under an existing TICTI-approved Constultant

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

When providing consultation intended to lead to Intensives Certification, I will provide guidance according to the TICTI treatment model

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

When writing an endorsement letter for a consultee's application for Intensives Certification, I will base my endorsement on TICTI-specified criteria

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 $250 promptly after the submission of this application form.

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