Center for Play Therapy

University of NorthTexas

Intensive Supervision Training

Summer 2015

Application due byApril 10, 2015

Name______

Address______

______

______

______

Email______

Phone______

Please respond succinctly to the following prompts.

List and describe your professional experience

  • Licenses/Certification
  • Number of years of mental health experience
  • Number of years of specific play therapy experience
  • Number of play therapy clients seen weekly
  • Current work setting
  • Tell us about the play therapy training you have had. (dates, number of hours)
  • List of university courses (include name of department, course number, and brief course description) related to play therapy
  • List play therapy related workshops and conferences you have attended
  • List Center for Play Therapy trainings you have attended (workshops, conferences, etc.)
  • List name of professionals you trained under and dates of training.
  • State your prior supervision experience you have received (style, clientele of focus)

What days of the Summer Institute are you planning on attending this summer?

Do you have any areas of expertise that you specialize in working with children?

Are you working towards your RPT? Where are you in the certification process?

Tell us about your theoretical orientation and rationale in utilizing this theory with young children in play therapy (max 1 page, doubled space, Times New Roman, 12 pt. font).

What are your goals for this Intensive Supervision experience?

Please attach your resume or curriculum vitae. Please ensure your name is on each page of your resume/ vita.

The intensive supervision training is conducted in English. Due to the nature of the training, you may be contacted for an interview prior to acceptance into the intensive.

Decisions will be made and you will be notified by April 17, 2015. There are two options available for payment. The total cost for the Intensive Supervision Experienceif you pay in full by May 25, 2015 is $895.00. If you prefer to split your payment into 2 payments, the total cost is $950.00. Upon acceptance, the first deposit of $500.00 is due May 1stand the remaining balance of $450.00 is due June1st. There will be a non-refundable processing fee of $100.00 in the event a participant withdraws from the experience after the initial payment is processed.

Please mail your completed form to

Center for Play Therapy, 1155 Union Circle, #310829, Denton, TX 76203-5017

Fax 940-565-4461 or email Alyssa Swan