Sept. 15th- Nov. 17th, 2026: Survivor-Centered Approaches to Treating Complex Trauma: A Course for Mental Healthcare Providers Application Survey

Thank you for your interest in Survivor-Centered Approaches to Treating Complex Trauma: A course for Mental Healthcare Providers. This is a 10-week online course that will meet once per week on Tuesday afternoons from 1:00pm-2:30pm EST. Completing this application is the first step in the approval process. We are accepting applications on a rolling basis. Any questions should be directed to the Training Department at mlmctraining@jri.org.

1.Personal Information(Required.)

Full Name

Job title

Credentials, e.g. licenses, pre-licenses, etc.

Work email

Phone number

2.Company Information(Required.)

Company name

Company address

City/Town

State/Province

ZIP/Postal Code

3.Please indicate all of the following that apply to you:(Required.)

Mental Health Professional (psychologists, social workers, counselors, couple & family therapists, expressive arts therapists, psychiatrists, psychiatric nurses, etc.)

Masters Degree or Higher

Licensed (or certified/registered) in your state (or province/country)

None of the above

Please provide any additional details that you feel makes you an appropriate candidate to participate in this training:

The training Understanding and Responding to Victims of Commercial Sexual Exploitation (CSEC 101) or an equivalent training is a prerequisite to attend this course.

4.What trainings on the commercial sexual exploitation of children (CSEC) have you completed? Please include the titles, hosting agency, and estimated date of attendance.(Required.)

5.Please indicate which of the following specialized trainings you have completed in the following clinical modalities.(Required.)

EMDR

TF CBT

Motivational Interviewing

Other (please specify)

None of the above

6.Are you interested in receiving CEUs for this course from NASW?(Required.)

Yes

No/Does not apply to me

If yes, please enter license number:

7.The live sessions will be recorded for the use of participants and ongoing quality improvement for instructors. Do you consent to being recorded for these reasons?(Required.)

Yes

No

8.Do you have any questions?