Faculty Application Registration Form Please complete the form below. Step 1 of 5 - Basic Information 20% Name* First Last Email* Phone*Application to provide (check all that apply):* Supervision Workshop presentations Training ReceivedHow many hours of didactic training in CBT have you received?*Please enter a number from 0 to 500.Trainer/Faculty name(s):*Training Provider Organizations* Supervision Received in CBTHow many hours of CBT supervision have you received?*Please enter a number from 0 to 500.Supervisor's name(s):*How many hours of supervised WORK experience in CBT have you received?*Organization:*Supervisor's name(s):* Experience Providing CBT SupervisionWhat patient populations have you provided supervision for?*Experience Presenting WorkshopsSpeaker Experience*TopicDate (dd/mm/yyyy)Workshop LengthOrganizationProfessional Discipline(s) of Audience Please list your experience presenting workshops. Use the plus sign to add additional trainings.Have you provided supervision and/or training in CBT in a language other than English?*NoYesWhich language(s)? CV Upload (pdf)*Accepted file types: pdf.
