120 8th Street South Fargo, ND 58103
(701) 293-1335
TCTY@sanfordhealth.org
Contact Us
Roster Applications
ABOUT US
Our Team
What We Do
Outcomes
History
Our Funders
STATEWIDE PROGRAMS
Project HEAL
Project REACH
Project SPARCS
TRAINING
Bring Your Own Lunch & Learn
TF-CBT Learning Collaborative
Honoring Children, Mending the Circle (HCMC)
ND Human Trafficking & Complex Trauma 201 Series
Learning Collaborative
Training Portal
TREATMENT
Child & Adolescent Treatments
Adult Treatments
Trauma Screening
AGENCIES & CLINICIANS
Agencies
Clinicians
RESOURCES
Find A Clinic
ABOUT US
Our Team
What We Do
Outcomes
History
Our Funders
STATEWIDE PROGRAMS
Project HEAL
Project REACH
Project SPARCS
TRAINING
Bring Your Own Lunch & Learn
TF-CBT Learning Collaborative
Honoring Children, Mending the Circle (HCMC)
ND Human Trafficking & Complex Trauma 201 Series
Learning Collaborative
Training Portal
TREATMENT
Child & Adolescent Treatments
Adult Treatments
Trauma Screening
AGENCIES & CLINICIANS
Agencies
Clinicians
RESOURCES
Find A Clinic
Seeking Safety for Adolescents Rostering Application
Home
Seeking Safety for Adolescents 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
Have you been certified in Seeking Safety?
*
Yes
No
Trainer name
*
Trainer organization
*
Seeking safety certification certificate
*
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
Message (Optional)
Comments
This field is for validation purposes and should be left unchanged.
58787
© 2024 Treatment Collaborative for Traumatized Youth. All rights reserved.