51³Ô¹Ï Therapeutic Specialty Designation Name(Required) First Last Email(Required) Enter Email Confirm Email 1) Select the types of program(s) for which you are qualified to offer advice and guidance. Select all that apply.(Required) Residential treatment centers Therapeutic schools Psychiatric hospitals Schools for students who display developmental disabilities, developmental delays, or neurological impairments Head injury programs Specialized programs for students with therapeutic needs Therapeutic wilderness programs Other If other, please explain:2) How many years have you worked with therapeutic clients?(Required)3) Describe the types of therapeutic clients you have helped and indicate how many therapeutic clients you have placed.(Required)4) Describe the protocol you use when determining options for a therapeutic student.(Required)5) Describe your educational training in mental health/counseling/psychology.(Required)6) List any psychological tests that you frequently interpret.(Required)7) List any tests that you frequently administer, and include your credentials to administer each of these tests (i.e., license, certification).(Required)8) Please list any relevant academic courses, professional development workshops, and seminars.TitleSponsoring Org.No. of HoursDate(s) Add Remove9) Evaluative Visits. A minimum of 50 visits to therapeutic institutions within the most recent five years is required. Upload a list of these schools or programs, and include the names of the institutions and the month/year of your visit.Upload Evaluative Visits list(Required)Max. file size: 50 MB. Questions or any supporting materials should be sent to [email protected]. Δ
