Intensive Supervision Experience

Intensive Supervision Experience

Center for Play Therapy

University of NorthTexas

Intensive Supervision Training

Summer 2018

Application due byMarch 5, 2018

Full Name:

Address:

(Street address, city, state, and zip code)

Email:

Phone:

Please respond succinctly to the following prompts.

1)List and describe your professional experience

  • Licenses/Certification
  • Number of years of mental health experience
  • Number of years of specific play therapy experience
  • Number of play therapy clients seen weekly
  • Current work setting
  • Tell us about the play therapy training you have had(dates, number of hours):
  • List of university coursesrelated to play therapy (include name of department, course number, and brief course description)
  • List play therapy related workshops and conferences you have attended
  • List Center for Play Therapy trainings you have attended (workshops, conferences, CCPT 101/CCPT 102, etc.)
  • List name of professionals you trained under and dates of training.
  • State your prior supervision experience you have received (style, clientele of focus)

2)Briefly describe your past experiences working with children and families.

3)What days of the Summer Institute are you planning on attending this summer?

4)Do you have any areas of expertise that you specialize in working with children?

5)Are you working towards your RPT? Where are you in the certification process?

6)Tell us about your theoretical orientation and rationale in utilizing this theory with young children in play therapy (max 1 page, doubled space, Times New Roman, 12 pt. font).

7)What are your goals for this Intensive Supervision experience?

8)Please attach your resume or curriculum vitae. Please ensure your name is on each page of your resume/ vita.

9)Do you anticipate needing additional accommodations? If so, please describe.

Please note, the intensive supervision training is conducted in English. Due to the nature of the training, you may be contacted for an interview prior to acceptance into intensive supervision.

Decisions will be made and you will be notified by April 2nd, 2018. Once you have been notified of your acceptance, payment of $995 is due no later than 5pm on April 12, 2018 to secure your spot (pay by phone or in person; no mail-in payment or on-line payment accepted). The CPT office is open Monday-Thursday, 10am-5pm. Due to the nature of this training, this training is limited to 12 participants (supervisor-participant ratio = 1:3)

Please submit your completed form to Kirsten Kram by January 16, 2018:

Center for Play Therapy, 1155 Union Circle, #310829

Denton, TX 76203-5017

Fax: 940-565-4461

Email:

Top View