TBT-S Level 1 and Level 2 Training Request Form
Date
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Month
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Day
Year
Date you are completing form.
Contact and Professional Demographic Information
Name
*
First Name
Last Name and Degree
Professional Degree
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*
Email
*
Address
Business, University, Medical Center, private practice etc. name
Street or PO and/or Suite
City
State / Province/ Country
Postal / Zip Code
Phone Number
*
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Country/Area Code
Phone Number
What is your Profession?
Psychologist
Social Worker
Counselor
Mental Health Practitioner
Occupational Therapist
Nurse
Physician
Dietitian
Medical Practitioner
Faculty/Teacher
Other
Type of Business
Hospital
University/Educational Setting
Private Practice
Out Patient Treatment Program
Clinical Team within a Treatment Setting
Mental Health Program
Other
Which TBT-S advanced Training Level are you requesting?
Level 2: Three-day face-to-face TBT-S Application.
Level 3: Four 2-hour virtual consultation sessions on TBT-S integration into treatment practice or programs over 1 year.
Prerequisites: Check all that are true for you:
Read the Temperament Based Therapy with Supports manual, by Hill, Peck and Wierenga, 2022.
Completed 6 hours of TBT-S Introductory Training face-to-face or virtually.
If applying for Level 3, you have completed Level 2.
If applying for TBT-S Approved Instructor, you have read the book, completed 1,2,3.
Check the Fee-box relevant to the Level of TBT-S training you request:
Level 2: Three-day face-to-face training @ price TBD.
Level 3: 6 hours of virtual consultation over 1 year: Price TBD
TBT-S is a Training Institute, not a treatment facility. It is not liable for the treatment provided in your professional setting. Do you agree to not hold TBT-S Training Institute liable for the treatment and educational outreach that you provide?
I agree
I don't agree
Questions?
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Comments?
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