DTAP® Certification Program
2026 Cohort Application
Personal Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Professional Background
Current Job Title
*
Organization (if applicable)
*
Field of Study
*
Please Select
Foster Care
Adoption
Juvenile Justice
Child Advocacy
Homeless
Sex Trafficking
Schools
Education
Religion
Legal/Court System
Corrections
Therapy/Counseling
International Outreach
Medical Professional
Social Work
Other
Years of Experience in the Field
*
Highest Degree Earned
*
Motivation and Goals
Why are you interested in the DTAP program?
*
What specific skills or knowledge do you hope to gain?
*
Please describe your trauma and attachment knowledge.
*
What other modalities do you and/or your agency implement?
*
Expectations
Are you able to commit to the necessary time and effort to complete this training program?
Participate in pre-work readings, webinars, etc.
*
Yes
No
Not Sure
Attend training sessions and complete assignments to prepare.
*
Yes
No
Not Sure
Participate in monthly consultation for six months.
*
Yes
No
Not Sure
Additional Information
Please provide any additional information or comments.
How did you hear about us?
Website
Social Media
Conference
Word of Mouth
Google Search
Other
I understand that for full certification, I am required to attend all training modules and follow up consultations.
*
I accept the terms and conditions.
Signature
*
Date signed
*
-
Month
-
Day
Year
Date
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