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* 1. What is your first and last name?

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* 2. How did you hear about this course? (APT announcement, FB/social media, PTIC newsletter, announcement at a conference or workshop, referral, other and indicate)

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* 3. What is the highest level of post secondary education you have completed and from where? Please describe your degree.

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* 4. Please describe the type of client you will be working with while enrolled in this course?

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* 5. How many years of experience do you have in the counseling field in general?

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* 6. How many years of experience do you have in the play therapy field?

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* 7. What modalities of play therapy have you studied?

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* 8. Have you studied Synergetic Play Therapy before? If so, what class and where?