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WHAT WE DO
Learning Collaborative
Results
History
Our Funders
Our Team
TRAINING
Bring Your Own Lunch & Learn
TF-CBT Learning Collaborative
Honoring Children, Mending the Circle (HCMC)
ND Human Trafficking & Complex Trauma 201 Series
Training Portal
TRAUMA SCREENING
TREATMENT
Child & Adolescent Treatments
Adult Treatments
AGENCIES & CLINICIANS
Agencies
Clinicians
RESOURCES
CONTACT
Roster Applications
Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) Rostering Application
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Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) Rostering Application
General Information
First Name
*
Last Name
*
Degree (ex. M.S., M.E.d)
*
License (ex. LPC, LPCC)
*
Personal Email Address
*
Professional Email Address
*
Personal Phone Number
*
Agency Phone Number
*
Agency Name
*
Agency Address
*
Agency City
*
Agency State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Agency ZIP Code
*
Agency County
*
Agency Type (ex. residential, inpatient, outpatient)
*
Agency Website
*
Treatment Information
Do you hold a masters degree or above in a mental health discipline?
*
Yes
No
License Number
*
License State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Proof of Degree
*
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Select files
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Have you completed the TF-CBT web training (https://tfcbt2.musc.edu/)?
*
Yes
No
Date of TF-CBT web training
*
MM slash DD slash YYYY
TF-CBT Web Training Certificate
*
Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
Have you completed a TF-CBT face-to-face training with a nationally certified TF-CBT trainer?
*
Yes
No
Face-to-face trainer name
*
Face-to-Face Training Completion Certificate
*
Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
Have you completed ongoing consultation calls or ongoing supervision as part of your TF-CBT training?
*
Yes
No
Consultation call trainer name
*
Consultation Call Completion Certificate
*
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Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
Have you treated 3 children or adolescents with TF-CBT?
*
Yes
No
Have you treated 2 children or adolescents with TF-CBT where there was active caregiver participation?
*
Yes
No
Are you nationally certified in TF-CBT?
*
Yes
No
National TF-CBT Certificate
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Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
Message (Optional)
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