Applicant Recommenders Information
For Applicants to Complete and submit
Program to which you are applying:
ICAF - Intermodal Creative Arts Facilitator
ICAT - Intermodal Creative Arts Therapist
Your Name
First Name
Last Name
Your Email
example@example.com
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Your Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If you live outside the US, please provide your complete mailing address and phone with country code below:
Your Recommenders
Please list the name, contact information, and nature of relationship (e.g., current supervisor, former supervisor, colleague, etc.) for each of your three Recommenders, below:
Recommender #1:
Recommender #2:
Recommender #3:
Rights & Privacy
Each applicant and Recommender are provided with a copy of the Rights & Privacy Statement to read as part of their recommendation form. Click/Tap below to read then check box
Please select one of the following:
I retain my right of access to my recommendations submitted for the CELA Intermodal Creative Arts Certification Programs
I waive my right of access to my recommendations submitted for the CELA Intermodal Creative Arts Certification Programs
Completing this Form
Read each statement, below, and check each of the corresponding boxes to acknowledge your agreement with the statement and to complete this form.
Read each statement then check the corresponding box:
I have read and understood the questions and information provided on this form
I have provided information that is accurate and correct to the best of my knowledge
I am the person named as the applicant on this form, above, and am the same person completing the form
Submit
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