TBT-S Approved Instructor Application Form
Date
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Month
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Day
Year
Date
Contact and Professional Demographic Information
Name
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First Name
Last Name
Degree
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Email
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example@example.com
Business Address
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Business name, private practice etc.
Street Address, P.O, or Suite
City
State / Province/Country
Postal / Zip Code
Phone number
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country code/phone number
What is your profession?
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Psychologist
Social Worker
Counselor
Mental Health Practitioner
Occupational Therapist
Nurse
Physician
Dietition
Medical Practitioner
Faculty/Teacher
Other ____________________________________________________
Type of Business
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Hospital
University/Educational Setting
Private Practice
Outpatient Treatment Program
Clinical team within a treatment setting
Mental health program
Other _________________________________________________________
Application requirement: Send the following Information to: Laura.Hill@TBTSTraining.com
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Current resume or curriculum vitae
Paragraph addressing number of years of eating disorder professional treatment/other mental or biological treatment experience; and why you are interested in TBT-S.
Two professional references
Training Requirements for TBT-S Approved Instructor are listed below. Check what you have completed thus far. A TBT-S Co-Developer will contract you to arrange the training of the unchecked areas:
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Read the Temperament Based Therapy with Support book by Hill, Peck and Wierenga, 2022.
Completed 6 hours and pass quizzes in Level 1 video courses on the website, or face-to-face training. This could focus on either or both adolescent and/or adult training.
Attend and assist in face-to-face Level 2 TBT-S Training for adolescent and/or adult.
Attend and assist in virtual Level 3 TBT-S Training
Present a TBT-S assigned training, under the supervision of a TBT-S Co-developer for Levels 1 and 2 training. Collect feedback from those trained to review participant feedback on your training.
Pass a TBT-S Exam on treatment/training information.
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 training that you provide?
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I agree
I don't agree
Submit
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