What is the name of the first clinician you would like to participate in the LC? What is the title of this clinician? Why was this person chosen to participate in the LC? What is the name of the second clinician you would like to participate in the LC? What is the title of this clinician? Why was this person chosen to participate in the LC? What is the name of the third clinician you would like to participate in the LC? What is the title of this clinician? Why was this person chosen to participate in the LC? Are there any other individuals you would like to participate in the LC? (If yes, please provide the information listed above for each individual you would like to include in the LC.) Supervisor Application be completed by the trainee. (To Each person listed above as an LC participant should complete the below application.) Applicant’s Name: Name of Agency: Job Title: Work Address: Phone Number: E-mail address: License Number and State of Licensure: Professional Discipline: Date of completion of TF-CBTWeb. (If not yet completed, please provide the projected completion date.): Describe any TF-CBT or CBT Training you have received, including participation in workshops, supervision, consultation calls, familiarity with TF-CBT manuals and books, etc.: How many years have you been providing therapy to children and families? What percent of your caseload do you believe could benefit from TF-CBT? How often do you see most of your clients? (e.g., weekly, monthly, etc.)? If you see your clients less than weekly, you be able to schedule TF-CBT clients for weekly sessions? Do you actively engage parents in treatment (i.e., participate in individual parent sessions and conjoint sessions with the child)? Please those settings in which you would implement TF-CBT after receiving training: Outpatient clinic
What is the name of the first clinician you would like to participate in the LC? What is the title of this clinician? Why was this person chosen to participate in the LC? What is the name of the second clinician you would like to participate in the LC? What is the title of this clinician? Why was this person chosen to participate in the LC? What is the name of the third clinician you would like to participate in the LC? What is the title of this clinician? Why was this person chosen to participate in the LC? Are there any other individuals you would like to participate in the LC? (If yes, please provide the information listed above for each individual you would like to include in the LC.) Supervisor Application (To be completed by the trainee. Each person listed above as an LC participant should complete the below application.) Applicant’s Name: Name of Agency: Job Title: Work Address: Phone Number: E-mail address: License Number and State of Licensure: Professional Discipline: Date of completion of TF-CBTWeb. (If not yet completed, please provide the projected completion date.): Describe any TF-CBT or CBT Training you have received, including participation in workshops, supervision, consultation calls, familiarity with TF-CBT manuals and books, etc.: How many years have you been providing therapy to children and families? What percent of your caseload do you believe could benefit from TF-CBT? How often do you see most of your clients? (e.g., weekly, monthly, etc.)? If you see your clients less than weekly, you be able to schedule TF-CBT clients for weekly sessions? Do you actively engage parents in treatment (i.e., participate in individual parent sessions and conjoint sessions with the child)? Please those settings in which you would implement TF-CBT after receiving training: Outpatient clinic
TF-CBT_Training.Application.docx