Black Play Therapy Phase 1 Application Form

Social Justice Play Therapy Training Program

This initiative is designed to support Black licensed mental health professionals in or beginning Phase 1 of the APT credentialing process.

Program Overview

The Foundation provides a comprehensive training program specifically designed to provide participants with the essential knowledge and skills required to fulfill the prerequisites of the Association for Play Therapy (APT) credentialing application. This program includes in-person sessions, live webinars, recorded training modules, and individual and group consultations.

Phase 1 focuses on foundational techniques to expand your play therapy knowledge and skills. Participants in the program will receive training and group and individual consultation from a Registered Play Therapist-Supervisor (RPT-S™), which is essential to their development of skills as play therapists. Additionally, participants will receive guidance with credentialing and preparation to submit their credentialing application to the Association for Play Therapy.

Training and Consultation

Phase and Cost: The Program is divided into two Phase 1 options, which cover training, materials, and RPT-S™ consultation. The Participant investment is:

Option A: $500 – Participants need up to 27 hours of training and no more than 5 hours of RPT-S™ consultation to complete the credentialing Phase 1 requirements.
Option B: $1000 – Participants are just getting started with RPT credentialing and need 55 hours of training and 10 hours of RPT-S™ consultation to complete the Phase 1 credentialing requirements.

Application Review and Payment

A Program Committee will review participant applications. Upon acceptance into the Social Justice training program, participants must pay in full for their selected phase option before the first scheduled training.

Verification of Phase 1: If you select Option A to qualify for this program, you must submit all requested documentation to verify that you have received the necessary training and RPT-S™ consultation regarding the credentialing process.

APT Credentialing Standards: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://cdn.ymaws.com/www.a4pt.org/resource/resmgr/credentials/standards_&_applications/rpt_standards.pdf

APT Credentialing Application: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://cdn.ymaws.com/www.a4pt.org/resource/resmgr/credentials/standards_&_applications/rpt_application.pdf

Name*

First NameLast Name

Licence Type*

Licence State & Number*

Licence Expiration Date*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Have you completed Phase 1 of the APT credentialing requirements?*

YesNoUnsure (The Foundation will review your training and consultation)

Choose your Phase 2 Program for Review:*

Option A: Participants need up to 27 hours of training and no more than 5 hours of RPT-S™ consultation to complete the credentialing phase 1 requirements.Option B: Participants are just getting started with RPT credentialing and need 55 hours of training and 10 hours of RPT-S™ consultation to complete the Phase 1 credentialing requirements.

Please write a 250-word statement explaining why you want to become a Registered Play Therapist™ and how you plan to use play therapy within the Black community. (Please ensure your statement is well-organized, clearly written, and reflects your genuine voice and intentions).*

We will be reviewing responses for

Upload your APT Application (Social Justice applications will not be accepted for Option A without a copy of your APT application. Your partially completed APT application will be used to verify that you have halfway completed Phase 1 of the credentialing process.*

Upload your CE certificates*

If you have any, upload your signed RPT-S™ Consultation Form (This is to verify how many hours you need to complete the required 35 hours).*

Consent and Acknowledgment I understand that acceptance into the "Social Justice" Program is contingent upon the submission of all requested documentation and a thorough review of my application.

Yes

Please upload an image for identity verification.

Signature

Date