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ABOUT US
Our Team
What We Do
Outcomes
History
Our Funders
STATEWIDE PROGRAMS
Project HEAL
Project REACH
Project SPARCS
TRAINING
Bring Your Own Lunch & Learn
TF-CBT Learning Collaborative
Honoring Children, Mending the Circle (HCMC)
ND Human Trafficking & Complex Trauma 201 Series
Learning Collaborative
Training Portal
TREATMENT
Child & Adolescent Treatments
Adult Treatments
Trauma Screening
AGENCIES & CLINICIANS
Agencies
Clinicians
RESOURCES
Find A Clinic
Honoring Children Mending Circles Trauma-Focused Cognitive-Behavioral Therapy (HCMC TF-CBT) Rostering Application
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Honoring Children Mending Circles Trauma-Focused Cognitive-Behavioral Therapy (HCMC TF-CBT) Rostering Application
General Information
First Name
*
Last Name
*
Degree (ex. M.S., M.E.d)
*
License (ex. LPC, LPCC)
*
Personal Email Address
*
Professional Email Address
*
Personal Phone Number
*
Agency Phone Number
*
Agency Name
*
Agency Address
*
Agency City
*
Agency State
*
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Alaska
Arizona
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Colorado
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Delaware
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Ohio
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Pennsylvania
Rhode Island
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Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Agency ZIP Code
*
Agency County
*
Agency Type (ex. residential, inpatient, outpatient)
*
Agency Website
*
Treatment Information
Are you licensed?
*
Yes
No
License Number
*
License State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
If no, do you work on a team with licensed clinicians?
*
Yes
No
Are you Alaskan Native?
*
Yes
No
Have you completed the TF-CBT web training (https://tfcbt2.musc.edu/)?
*
Yes
No
Date of TF-CBT web training
*
MM slash DD slash YYYY
TF-CBT Web Training Certificate
*
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Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
Have you attended and completed a 3-day training on HCMC?
*
Yes
No
Training date
*
MM slash DD slash YYYY
Trainer name
*
Trainer organization
*
HCMC training proof of completion
*
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Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
Have you completed consultation calls with a HCMC trainer?
*
Yes
No
Call dates
*
Call trainer name
*
Trainer organization
*
HCMC consultation call proof of completion
*
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Select files
Max. file size: 8 MB.
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Comments
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