Interest Form

Advanced Certificate in Dissociation Studies for EMDR Therapists
Interest Form

Name

First Last

EMDR Therapy Training Progress:

Already an EMDRIA-Approved Consultant

Already a EMDR Certified Therapist and Consultant-in-Training

Already a EMDR Certified Therapist

Working towards EMDRIA Certification

Completed full basic or foundational training in an EMDRIA-approved program

Currently working on basic or foundational training in an EMDRIA-approved program

Trained or Accredited in another EMDR system (e.g.., EMDR Europe, EMDR Australia)

None of the above

Statement of Intent

Submit a statement of intent (500-1000) words explaining your intention for committing to this program and describing what you are hoping to learn about yourself and others from this course of study. This statement must also include an explanation of the clinical learning that you hope to obtain as a result of this program. Your Statement of Intent can be submitted through the Submit Interest Form below. Applications that do not include the required Statement of Intent will be returned.

Statement of Intent Upload (Optional)

Use this upload if you prefer to write your Statement of Intent in another program and upload here.

Max. file size: 10 MB.

Name

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