Basic EMDR Therapy Training Course - Part 1
Oct. 14-18/2017
Application Form

I. Applicant Information:










Languages Fluent Good Satisfactory Weak
1.
2.
3.
Home Address
Contacts

II. Education & Experience:


University degrees: (starting with the most recent)

Degree Specialization University Year Country

Other Certificates:

Type Specialization Name of Institution Year Country

Training experience: (in psychotherapy, counseling, or psychological assessment)

Type of training received:
Number of years:
Psychotherapeutic approaches trained in (if any):

III. Current Work:


Current job(s) & position: (list if more than one job)
1. Main Work

2.

3.
Type of work:
Name of institution(s):
1.
2.
Main Work Address:

Clinical experience: (the actual practice and not the training)

Number of years of experience after the Master's degree:
Type of experience:

Types of psychotherapy you use in your work:

Psychological Disorders you work with:

Population you do treatment on:

Kindly, upload your documents here:






I certify that the information contained in this application is true and complete. I understand that
filling this application does not mean that I will be accepted to take this training course.
I also understand that the Standards Committee of EMDR Lebanon Association will study my
application based on my qualifications, degrees, and years of experience and will ask for an
interview before their final acceptance.

Date: 15/08/2018