Volunteer Application

Volunteer Registration

Psychological Support and Trauma Healing for those affected by the flash floods in Kerr County, TX
Your Name*

First NameLast Name
Email*

Confirmation Email
Phone*

Country/Area CodePhone Number
Location of your practice*

Street Address

Street Address Line 2

CityState

Zip Code
What is your professional title?*
Website (optional)
Years of experience in the field of mental health:*

2 or less2-55-1010-1515-2020 or more
Are you comfortable working with children and teenagers?

YesNo
Are you trained in Brainspotting?*

YesNo
Are you you certified?*

YesNo
List all Brainspotting trainings you have completed:*

Phase 1Phase 2Phase 3Phase 4Phase 5Master ClassIntensiveBrainspotting with ChildrenExpansionFirst Responders and MilitaryOther
What is your Brainspotting experience?*

Some experience (0-100 clients)Moderate Experience (100-200 clients)Very Experienced (>200 clients)ConsultantTrainer
List all anguages in which you can conduct sessions*

EnglishSpanishOther
How many clients do you have space for?*

12
Additional information (optional)

Please use the space below to list any additional information that might be helpful, such as:
- Populations you specialize in serving
- Experience with populations traumatized by war and disasters
- Time availability and flexibility
- Other states/provinces where you are licensed, besides your home state
Should be Empty:

Volunteer Registration