STA/ISST Teaching Member Application (CST-T-APP)

STA/ISST Teaching Member Application

Form CST-T-APP
Applicant
The detailed contact information from your STA Member Profile comprises the cover page of your application package. If you haven't yet filled it out, please do so now. If it's been a while since you did so, please make sure it's up to date using the edit link in the confirmation email you received when you submitted the profile form. If you no longer have that email, please contact sta@sandplay.org to request a link.
Name*

First NameLast Name
Email*
Date you became an STA/ISST Certified Sandplay Therapist*

MonthDayYear
Date requirements for Teaching Member completed*

MonthDayYear
Pseudonym of the client used for the final case in your CST application*
Pseudonym of the client used for your additional case study*
Please note that Jotform deletes draft entries after 2 months. If you choose to save and continue later, please return and submit the form within 2 months using the link in your confirmation email.

Conference Attendance & Presentation/Publication
Conference attended*
Either international congress or national conference with international Teaching Members present
Coference date(s)*
Conference location*
City and state, and country if outside USA
Conference presentation or publication*

I presented at a conferenceI published an article on sandplay
Presentation title*
Pseudonym of client(s) whose clinical material was used in this presentation*
Article title*
Journal name*
Date published*
DOI or URL*
e.g., https://doi.org/example.DOI.here

Co-Teaching
Co-Teaching Session #1: Fundamentals Course*
Co-Teaching Session #2*
Co-teaching evaluation format (select all that apply)*

My co-teachers completed Form CST-T-COT onlineMy co-teachers completed the paper Form 10Class participants completed form CST-T-EVAL onlineClass participants completed paper formsOther
Form 10 upload(s)*

PDF, JPG, or PNG format accepted
Cancelof
Summary report #1 of CST-T-EVAL forms*
URL of Jotform summary report
Summary report #2 of CST-T-EVAL forms
URL of Jotform summary report

Co-Facilitating
Co-Facilitating Session #1*
Co-Facilitating Session #2*
Co-facilitating evaluation format (select all that apply)*

My co-facilitators completed Form CST-T-COF onlineMy co-facilitators provided paper evaluationsOther
Upload co-facilitating evaluation(s)*

PDF, JPG, or PNG format accepted
Cancelof

Attestation
Please read the following before checking the box below:
Professional standards*

I, the applicant, have read, understood, and am committed to following and upholding the STA Standards for Professional Conduct and and ISST Code of Ethics and Rules of Procedure.
I, the applicant, hereby submit my application to be a Teaching Member in the Sandplay Therapists of America and the International Society for Sandplay Therapy. I understand that any misrepresentation in the information about myself that I have supplied may jeopardize my application and my Certified Teaching Membership with the International Society of Sandplay Therapists and Sandplay Therapists of America.
Signature*

Clear
Date signed*

MonthDayYear
Should be Empty:

STA/ISST Teaching Member Application