Application for the Couples Therapy Training Program2017-05-17T02:01:03+00:00
Please complete the form below to apply to the Couples Therapy Training Program. Any questions can be directed to Michael Wannon at menaw1@aol.com.
An application fee of $50 needs to accompany this application.  If you choose to pay that fee via credit card now, continue the application on this page.  If you prefer to pay by check, please click here.

Application Form - Couples Therapy Training

  • Drop files here or
    • Please list your current insurance carrier.
    • Drop files here or
      • List the College/University you attended, your Major, # of Credits, Degree and Date of Graduation.
      • List the name of the Institution, Course/Programs, Dates and Supervisors.
      • List your training & professional experiences, listing most current first. Include Dates, Client Age Range, Treatment Modality, Setting (Hospital/Clinic), Hours per Week, and Supervision (Type, Individual, Peer, Group, etc., and Frequency).
      • e.g. research, teaching, community work, writing, etc.
      • List the type of psychotherapy (individual, family, couples, group), the therapist's name(s) and theoretical orientation(s), when, how often, and how long.
      • Drop files here or
        • Couples Application Fee

        • A $50 application fee is required with the submission of the training application. this fee is non refundable, but will be applied to your tuition.
          Price: $50.00
        • $0.00
        • American Express
          Discover
          MasterCard
          Visa
           
        • This field is for validation purposes and should be left unchanged.