AEDP Institute Diversity Scholarship Application

Application Overview

We are very happy that you are interested in pursuing AEDP training.

We have limited slots for scholarships. We encourage you to honestly check in with yourself and ask: can I take this AEDP training without scholarship assistance, or, will I be unable to take this training without it?

Here’s an example of a former DS (Diversity Scholarship) recipient: they were an immigrant in the US, attended a university by taking out huge student loans, started to work as a social worker at a local not-for-profit agency where they serve immigrant populations, they live alone, and do not have any financial support from their family.

To apply, please answer ALL of the questions in sequence to support your application for a scholarship to this course. We will not process applications that do not answer all questions.

Lastly…Please know that if you can afford a course and receive a DS, that will take away a significant amount of funds from other therapists who genuinely need it. We’d deeply appreciate it if you are authentic and truthful in providing the information above. We rely on your honesty and integrity. We appreciate your understanding.

Thank you and we wish you the very best in pursuing training in AEDP.

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* 1. PLEASE TELL US TODAY'S DATE

Date / Time

Date

Time

AM/PM

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* 2. AEDP Institute Scholarships are course specific. Please tell us the name and date of the specific course/training/seminar for which you are applying to receive a scholarship

Course Name (ex: Immersion, ES1, Being Seen and Dopamine, etc.)

Course Date(s) (or NA for On Demand learning).

Other comments

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* 3. First name

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* 4. Last name

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* 5. Professional Suffix (LCSW, MFT, PhD, etc.)

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* 6. Email Address

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* 7. Phone Number including country code for numbers outside the USA

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* 8. Home Address

House Number and Street

City, State, Postal Code

Country

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* 9. I represent and warrant that I am a licensed mental health care professional in the field of psychotherapy or a similar profession, and that I accept and comply with all related professional and legal responsibilities. Specifically, I am a: (choose one below -- or if your profession is NOT included in the categories shown and you wish to apply, please email us at admin@AEDPInstitute.org)

Psychologist

Psychotherapist

Psychiatrist

Licensed Social Worker

Marriage and Family Therapist

Licensed Counselor

Other Licensed Mental Health Professional: Please specify:

AEDP Institute Diversity Scholarship Application

Application Overview

Question Title

* 1. PLEASE TELL US TODAY'S DATE

Question Title

* 2. AEDP Institute Scholarships are course specific. Please tell us the name and date of the specific course/training/seminar for which you are applying to receive a scholarship

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* 3. First name

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* 4. Last name

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* 5. Professional Suffix (LCSW, MFT, PhD, etc.)

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* 6. Email Address

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* 7. Phone Number including country code for numbers outside the USA

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* 8. Home Address

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* 10. License Number - or if you are from a country where licensing is not required, please explain here

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* 11. Do you self identify as Black?