Intensives Certification 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

Certificate of Completion of PC or EMDR Training(Required)

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

Certificate of Completion of TICTI's week-long Intensives Training(Required)

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

Certificate of Completion of TICTI's Advanced Methods in Intensive Trauma-Focused Therapy Training(Required)

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

Documentation of Completion/Passing the Intensive Exam(Required)

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

Documentation of Completion of 12+ PC or EMDR Group Consultation hours (provided by a TICTI-accredited PC/EMDR Consultant) or Completion of TICTI's Certificate Program(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 3 clients, for a total of at least 12 full days.

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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