AEDP Institute Diversity Scholarship and Pay What you Wish Application

Application Overview

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

We have developed this scholarship program to inspire and support mental health professionals on their AEDP journey who, due to economic needs and other unique barriers, could not otherwise attend our trainings without receiving a scholarship. Our basic scholarship is 35% and the number of scholarships offered for any given course are limited. While most scholarships will not fully defray the cost of our training, we hope that it will help relieve some of the financial burden of participating in AEDP training.

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?

To apply, please answer ALL 17 questions for your application to be processed. We will not process incomplete applications- there are 2 pages.

Lastly….We’d deeply appreciate it if you are authentic and truthful in providing the information above. 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 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. 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, Advanced Skills, On Demand )

Course Date(s) (Month, Day, Year)

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 and Pay What you Wish Application

Application Overview

Question Title

* 1. PLEASE TELL US TODAY'S DATE

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* 2. 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?