January 14-March 18th, 2025: Survivor-Centered Approaches to Treating Complex Trauma: A Course for Mental Healthcare Providers Application

Thank you for your interest in Survivor-Centered Approaches to Treating Complex Trauma: A course for Mental Healthcare Providers. This is a 10-week online course that will meet once per week on Tuesday afternoons from 12:00pm-1:30pm EST. Completing this application is the first step in the approval process. We are accepting applications on a rolling basis. Any questions should be directed to the Training Department at mlmctraining@jri.org.

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* 1. Personal Information

Full Name *

Job title

Credentials, e.g. licenses, pre-licenses, etc.

Work email *

Phone number *

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* 2. Company Information

Company name

Company address

City/Town

State/Province

ZIP/Postal Code

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* 3. Please indicate all of the following that apply to you:

Mental Health Professional (psychologists, social workers, counselors, couple & family therapists, expressive arts therapists, psychiatrists, psychiatric nurses, etc.)

Masters Degree or Higher

Licensed (or certified/registered) in your state (or province/country)

None of the above

Please provide any additional details that you feel makes you an appropriate candidate to participate in this training:

The training Understanding and Responding to Victims of Commercial Sexual Exploitation (CSEC 101) or an equivalent training is a prerequisite to attend this course.

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* 4. What trainings on the commercial sexual exploitation of children (CSEC) have you completed? Please include the titles, hosting agency, and estimated date of attendance.

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* 5. Please indicate which of the following specialized trainings you have completed in the following clinical modalities.

EMDR

TF CBT

Motivational Interviewing

Other (please specify)

None of the above

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* 6. Are you interested in receiving CEUs for this course from NASW?

Yes

No/Does not apply to me

If yes, please enter license number:

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* 7. The live sessions will be recorded for the use of participants and ongoing quality improvement for instructors. Do you consent to being recorded for these reasons?

Yes

January 14-March 18th, 2025: Survivor-Centered Approaches to Treating Complex Trauma: A Course for Mental Healthcare Providers Application

Question Title

* 1. Personal Information

Question Title

* 2. Company Information

Question Title

* 3. Please indicate all of the following that apply to you:

Question Title

* 4. What trainings on the commercial sexual exploitation of children (CSEC) have you completed? Please include the titles, hosting agency, and estimated date of attendance.

Question Title

* 5. Please indicate which of the following specialized trainings you have completed in the following clinical modalities.

Question Title

* 6. Are you interested in receiving CEUs for this course from NASW?

Question Title

* 7. The live sessions will be recorded for the use of participants and ongoing quality improvement for instructors. Do you consent to being recorded for these reasons?

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* 8. Do you have any questions?