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RMPTI REGISTRATIONFOR ON-LINE SUPERVISION PROGRAM

Name

 
Date
Email address:

University Degrees(s) & Dates

Relevant Training & Professional Experience:

SUPERVISION ACTIVITIES:
Please indicate the primary supervision activities that you would like to organize. The credit total should equal 8. If you wish to use more than the assigned credits for each activity; enter your desired number of credits per activity. Again, the total number of credits should equal 8.
ACTIVITY
SUGGESTED CREDITS CREDITS REQUESTED
1. Video tape segment review
2 enter credit
2. Feedback on written report
2 enter credit
3. Case notes: format and review
1 enter credit
4. Ethical Issues
2 enter credit
5. Court Preparation
3 enter credit
6. Practice Issues i.e. Parent consultation,
Securing private practice referrals, Special populations
1 enter credit
7. Case conceptualization and consultation
2 enter credit
8. Play therapy strategies
1 enter credit

To submit form via email, click on SUBMIT button.

Please click here to read and forward the OnLine Supervision Agreement which is required for registration


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