Application to apply for the orientation training to become Accredited EMDR Therapy Trainer ( Part 2)

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1. Provide academic degrees, and year of award, Institution (Minimum qualification is Masters’ degree in Mental Health from a regular course)

• Please provide copies of your academic degrees.

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2. License to practice as a mental health professional (where applicable).

• You must provide a copy of your licence/registration as a mental health practitioner or clinician in your own country/SAR (If applicable in your country/SAR)

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3. Basic training with EMDR Therapy:

a. Basic Training received in (year, place) Part 1

b. Basic Training received in (year, place) Part 2

c. Training organization responsible for the training

d. Consultation received from

e. Please submit the records of your progress of EMDR Therapy Part 1 Trainer’s Training and a letter of recommendation from your mentor/ trainer that you are eligible for attending the Orientation Workshop for the Trainers Training of EMDR Therapy Part 2.

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4. Experience as a Facilitator at EMDR Basic Trainings:

• Please provide proof of attendance at a minimum of 4 complete training courses, (all parts), where you were assessed to have successfully facilitated small group live practice and practical exercises, including work with Cognitive Interweave techniques. (Written confirmation must be provided by training organization).

• This could be mentioned by your mentor/ trainer/president of EMDR Association in the letter of recommendation

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5. Teaching experience:

• Please provide example of general teaching experience.

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6. You have supplied 1 Video of your clinical work, a full unedited EMDR session of your client work which demonstrates the highest professional standards in the application of EMDR, plus your clinical use of the Cognitive Interweave (refer to appendices for the guidelines of video).

• Please provide proof of attendance at a minimum of 4 complete training courses, (all parts), where you were assessed to have successfully facilitated small group live practice and practical exercises, including work with Cognitive Interweave techniques. (Written confirmation must be provided by training organization).

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8. Teaching experience:

• Please provide example of general teaching experience.

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9. You have supplied 1 Video of your clinical work, a full unedited EMDR session of your client work which demonstrates the highest professional standards in the application of EMDR, plus your clinical use of the Cognitive Interweave (refer to appendices for the guidelines of video).

YesNo

7. It is essential that members of the EMDR Training Faculty maintain the highest ethical standards in teaching and in clinical practice.

a. Have you ever been convicted of any criminal offence in any court in your country, or elsewhere, which might prejudice the public's trust in you, your profession or EMDR Asia?YesNo

b. Have you ever been found guilty of a civil offence?YesNo

c. Have you been refused or expelled from membership of any other professional body/ register on the grounds of professional misconduct or other professionally related offence?YesNo

d. Have you ever been the subject of any ethical /professionally related disciplinary action (which may or may not have ended in dismissal)?YesNo

e. Are you currently/ likely to be subject of any criminal, civil, investigatory or disciplinary proceedings or enquiries?YesNo

f. To your knowledge, have you ever been, or are you likely to be involved in a situation or incident that may result in disciplinary action against you as a member of EMDR Asia?YesNo

If you have answered yes to any of the above, please attach a detailed description of the situation and the resolution.

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"I confirm that all statements and evidence I have provided to the committee is truthful. I further confirm that I will behave at all times with integrity in my teaching and practice, and that I will adhere to the ethical and professional standards and rules of EMDR Asia."Yes

11. Letters of recommendation:

Each applicant must submit a minimum of two letters of recommendation (by their trainer, consultant/mentor/ president of local EMDR Association). The letters should address the applicant’s clinical skills and style, facilitation and consultation skills, teaching skills and ability to communicate with clarity, attitude and ability to work well with a team, and ethical professional behavior. The confidentiality of contents of letter be maintained.

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Therapy Trainer Form ( Part 2)