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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
Cognitive Processing Therapy (CPT) Rostering Application
Home
Cognitive Processing Therapy (CPT) 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
*
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Alaska
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Armed Forces Americas
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Agency ZIP Code
*
Agency County
*
Agency Type (ex. residential, inpatient, outpatient)
*
Agency Website
*
Treatment Information
Mental health license information
License Number
*
License State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
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Maine
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Tennessee
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Utah
Vermont
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Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Have you completed the CPT web training (https://cpt.musc.edu/)?
*
Yes
No
Date of CPT web training
*
MM slash DD slash YYYY
CPT web training completion certificate
*
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Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
Have you participated in and completed a live CPT training?
*
Yes
No
Date of training
*
MM slash DD slash YYYY
Trainer name
*
Trainer organization
*
CPT live training proof of completion
*
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Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
Did you complete and participate in CPT consultation calls as part of your CPT training?
*
Yes
No
Date of consultation calls:
*
MM slash DD slash YYYY
Name of trainer on calls
*
Trainer organization
*
CPT consultation calls proof of completion
*
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Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
If the completion of your CPT consultation calls were more than 3 years ago - have you renewed your certification?
*
Yes
No
Proof of certification renewal, if more than 3 years since trainings
Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
Message (Optional)
Name
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