RMPTI
RMPTI

 
RMPTI Application for Supervision

Please fill in the following form. You are also required to read and forward the OnLine Supervision Agreement which is required for registration. To view this form click here (pdf document) You will need Adobe Reader

Last name

First name

email verify email

mailing address

city province/state

postal code/zip country

phone number with area code

List University Degree(s)/Highest Academic Achievement & Dates Received

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.

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Cancellation Policy

The deposit is non-refundable. No refunds of course fees will be provided for any reason whatsoever unless there is illness or a death in the family. RMPTI will require a doctor's certificate or funeral information. Participants meeting this criteria will be provided with credit to attend an equivalent course (time, content, fee). This credit will be available to the participant for a period of one year from date of issuance. Rocky Mountain Play Therapy Institute reserves the right to cancel any course in the event of unforeseen circumstances. In such an event, an attempt will be made to notify registrants at least two weeks prior to the course start date and the full registration will be returned. In all instances, RMPTI's liability is limited to refund of registration fees only.

 
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RMPTIRocky Mountain Play Therapy Institute
1318-15th Avenue SW Calgary, Alberta, Canada T3C0X7
Phone: 403-245-5981
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