Attachment and Trauma Center Of Houston New Therapist Application
Name
First Name
Last Name
Date Of Birth
Address
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Educational Background
Highest Degree Earned
Field Of Study
Name Of Institution(s) Attended
Graduation Date
Relevant Coursework (if needed)
Work Experience
Current Or Most Recent Postion
Organization Name
Job Title
Dates Of Employment
Brief Description Of Responsibilities
Previous Clinical Or Related Experiences
Licensing and Certifications
Type Of License/Certifications (e.g., LPC-Intern, LMSW, etc.)
Licensing State
License Number
Expiration Date
Personal Statement
A written statement (500-1000 words) explaining your interest in trauma therapy and why you wish to train at the Attachment & Trauma Center of Houston. This could include:Your motivation and passion for working in the field of traumaAny relevant experiences that have shaped your career goalsYour long-term aspirations in trauma-focused therapyHow you believe the training will benefit your professional development
Letter Of Recommendation
Request 1-3 letters of recommendation from professors, supervisors, or colleagues who can speak to your skills, character, and potential as a trauma therapist. Please email to admin@atchouston.com once acquired
Resume
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Background Check Consent
I consent to a background check, which may be required for clinical placements.
Yes
No
Ethical Agreement
I acknowledge that I must adhere to the ethical and legal guidelines of the licensing board of Texas.
Yes
No
Ethical Agreement
Availability
What days and times are you available for training, supervision, and clinical practice?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Are you interested in part-time or full-time?
Full-time
Part-time
Either
Emergency Contact Information
Emergency Contact
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Relationship To Applicant
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