Application to participate in Diana Fosha’s Magnificent ‘9+1’ Online Course: Fridays 2 pm – 4 pm Eastern, June – October 2020

Thank you for applying to participate in Diana Fosha's Magnificent '9+1' Online course. All applicants will be notified within 5 business days of one of the following results: - acceptance to the course, - acceptance to the course waiting list, or - ineligibility at this time (due to Level requirements). Accepted participants will be sent registration and payment information along with your acceptance. Please let us know at that time whether you would like to apply for a Diversity Scholarship or if you need financial support due to challenges related to COVID. Thank you!

Name
First Last
Email
Where do you live?
City State / Province / Region Country
License Type - Required for North Americans and wherever licensing is required for mental health therapists.

example: LCSW, MFT, PsyD, etc.
License Number - Required for North Americans and wherever licensing is required for mental health therapists.
YOUR AEDP LEVEL: This course is designed for advanced AEDPers - generally Level 3 or above.*
Level 3 AEDPers have completed Immersion plus at least 1 major course of supervision (core training, 20+ hrs individual supervision or 30+ hrs group supervision) AND (i.e. PLUS) any 2 of the following: ES1, ES2, Core Training, 20 hours individual supervision, 30 hrs group supervision. Please indicate your Level below for more information on training levels go to: https://aedpinstitute.org/certification/training-levels/
Have you been an Experiential Assistant in Essential Skills*
Notes regarding why I hope to be given an exception to the Level prerequisite