Employer/Organization Details

Organization name

Type of Setting ((hospital, residential, private practice, school, community program, etc.)

City / State / Country

Primary Contact (Decision-Maker)

Primary Contact Name

Title Clinical Director, Program Manager, HR, Owner, etc.)

Email *

Phone *

Therapist(s)to be Enrolled

Names of Therapists you are considering enrolling. Include discipline and population served.

Please include therapist emails as well.

Program Interest & Fit

Just a few quick check-boxes:

We are exploring professional development funding

We want to enroll a therapist in the next cohort

We’d like additional program details

We’d like to speak with someone on the team

Training Goals

What outcomes are you hoping to support by investing in this training?

Examples employers may mention: reduce crisis behaviors, support complex trauma clients, strengthen care team alignment, build DBT services

Timeline

When are you hoping the therapist could begin training?

Next available cohort

Within 3–6 months

Not sure yet

Funding

Employer-funded

Shared employer/therapist funding

Therapist-funded

Undecided

Optional Notes

Anything else you’d like us to know?

By submitting this form you’ll receive program details and next-step options. We respect your time and never spam.

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

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