CCT Intensive Application - Mental Health Professionals

Complete and submit the form below and we will review your application.

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Which Intensive Are You Interested in?(Required)

Level 1 Certification - Introduction to CCT

Level 2 Certification - Increasing Competence in CCT

Full Legal Name(Required)

First Last

Email(Required)

Address(Required)

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

Phone(Required)

Educational Background (Optional)

College Degree(Required)

Master's/Doctoral Degree (If Applicable)

Certifications (If Applicable)

Employment Background (Optional)

Relevant Past Employments & Volunteer Positions

Current Employment(Required)

Professional Title

Organization/Practice Name(Required)

What is your primary area of focus in your practice? (e.g., counseling, psychiatry, social work, school psychology)(Required)

How many years have you been practicing in the field?(Required)

Are You Currently Licensed?(Required)

Yes

What populations do you primarily serve?