EGPS Training Program in Group Psychotherapy Application- 2024-2025 Class

Eastern Group Psychotherapy Society

Training Program in Group Psychotherapy
All information is required
Full Name*
Degree(s) & Certification(s)*
Cell #*
Email*
example@example.com
Complete Address*
Profession*
Current Position*
Agency/Organization (if applicable)
If you are currently leading group(s) please describe*
How did you learn about this training program? (if from a person, please specify)*
Briefly explain your interest in applying to the Program and what you hope to gain professionally and personally.
Have you ever participated in any sort of experiential, process or insight-oriented groups? If yes, please briefly describe.
You must submit your CV with this application. Please use the box below to download your CV.
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There is a $50 non-refundable application fee for this Program. You must provide your credit card information when you submit your application.
Name on Credit Card*
Expiration Date*

MonthDayYear
Date
Credit Card #*
CVC Code*
For more information for questions please contact the Co-Directors of Admissions:

Fanita Henderson at fanita.henderson@gmail.com

or

Ashely Leeds at ashley@leedspsychotherapy.com
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All information is required