EALC Application - AEDP™ Institute

Your Full Name*

First Last

Your Email*

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COUNTRY*

Please tell us the country where you work and are licensed.

Please tell us about your license / credentials*

The role of EA is for mental health care professionals in the field of psychotherapy or similar professions. Tell us what type of license you have - choose from below, or complete the "other" option

other, if needed, from above: Other Licensed Mental Health Professional" license or credential

Please confirm that you have completed the prerequisites to be an Experiential Assistant*

In addition to Immersion and Essential Skills (ES1), you should have completed some supervision AND/OR some core training AND/OR some Advanced Skills such that a supervisor or Advanced Skills EA would recommend you to be an Immersion EA Or, ask for an exception - and please explain. Thank you!

required: I have completed Immersion
I have been an EA/Shawdowed in an AEDP Immersion Course
required: I have completed Essential Skills (ES1)
I have been an EA/Shawdowed in AEDP Essential Skills (ES1)
I have completed some Advanced Skills (ES2) Training
I have completed some/all Core Training
I have been in AEDP supervision

If you have a recommendation from a Supervisor, Faculty member or an Experiential Assistant in your experiential group, tell us about it!

What languages do you speak?*

Certain courses will include some participants who prefer to do experiential work in other languages other than English. Please tell us about your proficiency in English and in other languages.

I am fluent in English
I am fluent in Other Languages, see below

Other languages I am fluent in

Social Identitites: languages spoken, countries lived in, age and gender identity, race, religion and ethnicity, sexuality, ability, more

**This information will be used ONLY to enhance diversity among EAs in our courses. ** Please tell us whatever you want us to know about your social identities and, if you wish, the identities of the clients you serve.

Why do you want to be an Experiential Assistant?*

Are you pursuing AEDP Certification?*

Yes
No
Maybe / undecided

Space to tell us anything else you want us to know: