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Please indicate which Training(s) you are applying for:

List your education, degrees and clinical license status:

Describe your experience in the mental health setting, years of experience, populations served, etc.:

List all Sandplay courses you have taken, with whom and approximate dates:

List any Sandplay consultation you have done, with whom and type (individual, group or combination):

Confidentiality Agreement
By assigning my name hereunder, I agree that if I am accepted to participate in the training(s), I will uphold the highest standards of professional confidentiality, adhering strictly all all times to all laws and ethics governing the protection of client confidentiality. I agree to disguise any and all identifying information during case presentation, and I agree that I will hold confidential any and all clinical material shared during the course of case presentations.

I acknowledge that such intensive study of unconscious material requires significant personal growth and transformation and affirm that I am sufficiently physically fit & emotionally sound to undertake this training. I agree to remain responsible for my own well being throughout the training.

Yes, I agree.

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