1.What is your first and last name?

2.How did you hear about this course? (APT announcement, FB/social media, PTIC newsletter, announcement at a conference or workshop, referral, other and indicate)

3.What is the highest level of post secondary education you have completed and from where? Please describe your degree.

4.Please describe the type of client you will be working with while enrolled in this course?

5.How many years of experience do you have in the counseling field in general?

6.How many years of experience do you have in the play therapy field?

7.What modalities of play therapy have you studied?

8.Have you studied Synergetic Play Therapy before? If so, what class and where?