Application for Crisis Specialist Training & Certification

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* 1. First and Last Name

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* 2. E-mail address

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* 3. Phone Number

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* 4. Birthdate

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* 5. Enter the name of your organization.

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* 6. My organization is a member of the American Association of Suicidology.

Yes

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* 7. Enter your education history (Post high school. Begin with most recent).

Institution

City/State

Dates Attended

Degree/Certification

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* 8. Enter your education history (Post high school. Begin with most recent).

Institution

City/State

Dates Attended

Degree/Certification

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* 9. Enter your education history (Post high school. Begin with most recent).

Institution

City/State

Dates Attended

Degree/Certification

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* 10. Enter your clinical experience in direct crisis work. (Any volunteer or paid position you have held to calculate your total hours performing crisis intervention - You must have 3mo full-time or 6mo part-time to be a candidate).

Agency

Title

City/State/Province

Dates

# of weeks

# of hours each week doing crisis intervention

Total hours performing direct crisis work in this position

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* 11. Enter your clinical experience in direct crisis work. (Any volunteer or paid position you have held to calculate your total hours performing crisis intervention).

Agency

Title

City/State/Province

Dates

# of weeks

# of hours each week doing crisis intervention

Total hours performing direct crisis work in this position

Question Title

* 12. Enter your clinical experience in direct crisis work. (Any volunteer or paid position you have held to calculate your total hours performing crisis intervention).

Agency

Title

City/State/Province

Dates

# of weeks

# of hours each week doing crisis intervention

Total hours performing direct crisis work in this position

Question Title

* 13. Enter your clinical experience in direct crisis work. (Any volunteer or paid position you have held to calculate your total hours performing crisis intervention).

Agency

Title

City/State/Province

Dates

# of weeks

# of hours each week doing crisis intervention

Total hours performing direct crisis work in this position

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* 14. Upload proof of 40hrs Crisis/Clinical Training here. (This can be workshops, academic coursework, job training, etc. Transcripts must be uploaded to consider academic coursework. The training must have occurred within the last 3 years.)

Upload your Crisis/Clinical Training log and/or transcripts here.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 15. Upload a letter of support from someone who is directly acquainted with your work.

Upload file

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 16. Resume or CV upload

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 17. I understand the training is non-refundable and non-transferrable.

Yes

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* 18. Enter the contact information below for payment

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Application for Crisis Specialist Training & Certification

Question Title

* 1. First and Last Name

Question Title

* 2. E-mail address

Question Title

* 3. Phone Number

Question Title

* 4. Birthdate

Question Title

* 5. Enter the name of your organization.

Question Title

* 6. My organization is a member of the American Association of Suicidology.

Question Title

* 7. Enter your education history (Post high school. Begin with most recent).

Question Title

* 8. Enter your education history (Post high school. Begin with most recent).

Question Title

* 9. Enter your education history (Post high school. Begin with most recent).

Question Title

* 10. Enter your clinical experience in direct crisis work. (Any volunteer or paid position you have held to calculate your total hours performing crisis intervention - You must have 3mo full-time or 6mo part-time to be a candidate).

Question Title

* 11. Enter your clinical experience in direct crisis work. (Any volunteer or paid position you have held to calculate your total hours performing crisis intervention).

Question Title

* 12. Enter your clinical experience in direct crisis work. (Any volunteer or paid position you have held to calculate your total hours performing crisis intervention).

Question Title

* 13. Enter your clinical experience in direct crisis work. (Any volunteer or paid position you have held to calculate your total hours performing crisis intervention).

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* 14. Upload proof of 40hrs Crisis/Clinical Training here. (This can be workshops, academic coursework, job training, etc. Transcripts must be uploaded to consider academic coursework. The training must have occurred within the last 3 years.)

Question Title

* 15. Upload a letter of support from someone who is directly acquainted with your work.

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* 16. Resume or CV upload

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* 17. I understand the training is non-refundable and non-transferrable.

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* 18. Enter the contact information below for payment

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* 19. How did you learn of our trainings? (social media, professional organization, membership call, colleague/friend, membership email, etc)