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Externship Registration
Complete the form below to register for the Externship.
"
*
" indicates required fields
Name
*
First
Last
Email
*
Phone
*
Address
*
Street Address
City
Alabama
Alaska
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Arizona
Arkansas
California
Colorado
Connecticut
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District of Columbia
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Wisconsin
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Armed Forces Americas
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Armed Forces Pacific
State
ZIP Code
Please Note:
EFT Externships and Advanced Core Skills are designed for Mental Health Professionals and trainees. Participants are required to note their professional affiliation on the registration.
Profession
*
Psychologist
Social Worker
Marriage and Family Therapist
Counselor
Psychiatric Nurse
Psychiatrist
Student
Other
State / License Number
Agency Affiliation
Choose One:
*
I have the training and educational qualifications. to legally practice as a mental health practitioner
I am in formal training to be a mental health practitioner.
Will You Need CEU's?
*
Yes
No
If YES, please provide State license number.
How did you hear about the Externship?
*
Email from PCEFT
EFT Listserv
Friend/Colleague
Internet
PCEFT website
Google Ad
Other
Hidden
Date
MM slash DD slash YYYY
Payment
Early-bird Fee - $995
CMH Clinician*, Equity**, Student - $650
Externship Refresher (If you've previously taken an EFT Externship) - $650
Discount for September 2022 EFT Intro/Refresher Course Attendees - $935
When did you take your initial externship?
Where did you take it?
Total
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