Step 1 of 6 0% Name of Your Nonprofit or School*Location* Create a Username*Create a Password* Enter Password Confirm Password Name* First Last Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CompanyProfession*License Type (If unlicensed, specify if student, intern, etc) **License Number (If unlicensed, specify if unlicensed or if license is pending)*Select the State You Are Licensed In (If unlicensed, select state of residence) **AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Have You Taken Part I Before?*YesNoWho was your training provider for Part 1?When did you take Part 1? MM DD YYYY Part I and Part II EMDR basic training requires 5 consultations each. Please note that completing Part I and Part II training and these 10 consultations are a requirement of becoming an EMDR therapist. Consultations are a separate fee and may be purchased from EMDR Educators of Florida for just $25.00 per consultation.*Please acknowledge the above by by typing, "I agree" * By checking this box, you agree to complete the entire EMDR training within 24 months from your initial start date - this includes the lecture, practice, and 10 hours of required consultation that comprise the EMDR Training Course. If your initial start date was before January 1, 2017, you have until December 31, 2018 to complete the EMDR Training Course. * I understand all financial obligations must be satisfied before CEUs are granted * I understand that the training requires that I participate in the practicum as a client with real life issues and as a therapist.
