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6685 Gunpark Drive, Suite 102
Boulder, CO 80301
Phone: (303) 652-4035
Fax: (303) 652-4039
www.traumahealing.com
*Please note: Incomplete applications will not be accepted. Please
submit all documents when you submit your application or it will be returned
to you. For letters of reference, please have faculty member send the letter
directly to you, not the FHE office.
Date: _________________________________________________________________
Name: ________________________________________________________________
I am submitting my application and requested information to be considered
as one of the following:
_____ General Assistant _____ Primary Assistant _____ Senior
Assistant
Personal Session Provider: ___ Beginning ___ Intermediate
___ Advanced
Individual Case Consult Provider: ___ Beginning ___ Intermediate ___ Advanced
Group Case Consult Provider: ___ Beginning ___ Intermediate ___ Advanced
Please fill out the relevant section below, and submit the
required documentation along with the completed checklist.
ASSISTING — General
All levels
___ Letter of recommendation from faculty attached
___ Current CV attached
___ I belong to a professional association with its own Code of Ethics
My membership expires _______________
___ I carry professional liability insurance My policy expires _________________
Beginning
___ I have completed the Intermediate year of training
Intermediate
___ I have completed the Advanced year of training
___ I have assisted at all modules of the Beginning year (assistant’s
log attached)
Advanced
___ I am an SEP
___ I have assisted at all modules of the Intermediate year (assistant’s
log attached)
ASSISTING — Primary
All levels
___ Letter of recommendation from faculty attached
___ Current CV attached if copy on file with FHE is more than 3 years old
___ I belong to a professional association with its own Code of Ethics
My membership expires _________________
___ I carry professional liability insurance My policy expires _________________
___ I am an approved session provider for the year for which I am applying
to assist
Intermediate
___ I have provided sessions for credit for Beginning year students
Advanced
___ I have provided sessions for credit for Intermediate year students
ASSISTING — Senior
___ Letter of recommendation from faculty attached
___ Current CV attached if copy on file with FHE is more than 3 years old
___ I belong to a professional association with its own Code of Ethics
My membership expires _________________
___ I carry professional liability insurance My policy expires _________________
___ I am an approved session provider for the Advanced year
___ I am an approved provider of individual case consultations for the Advanced
year
___ I am an approved provider of group case consultations for the Advanced
year
___ I have been providing group case consultations for at least one year,
or have given a
minimum of 5 group case consultations
___ I have assisted at 2 full cycles of all levels of training
SESSION PROVIDER
All levels
___ I am an SEP
___ I have assisted at all modules of the year for which I am applying for
provider status
___ I have an active SE practice and have provided at least 150 SE sessions
to clients
to date
___ I belong to a professional association with its own Code of Ethics
My membership expires _________________
___ I carry professional liability insurance My policy expires _________________
Intermediate
___ I am an approved session provider for the Beginning year and have provided
at this level for one year, or 20 sessions, whichever comes first.
___ I have provided sessions for credit for Beginning students
Advanced
___ I am an approved session provider for the Intermediate year and have
provided at this level for one year, or 20 sessions, whichever comes first.
___ I have provided sessions for credit for Intermediate students
INDIVIDUAL CASE CONSULTANTS
All levels
___ I have had a professional practice in a related field for a minimum of 5 years, although a minimum of 10 years is highly recommended.
___ I have assisted at least 2 full cycles of the year for which I am applying
for provider
status
___ I have assisted at least once for a full cycle of an Intermediate and
an Advanced
training
___ I have given at least 300 SE oriented sessions to date
___ I a minimum of 5 years of experience in SE practice (this may include the time spent in the SE training.)
___ Recommendation letters from 2 faculty members attached
Intermediate
___ I have given a minimum of 20 individual case consultations for Beginning
students
___ I have assisted at least 2 full cycles of the Intermediate year
___ Recommendation letters from 2 faculty members attached
Advanced
___ I have given a minimum of 20 individual case consultations for Intermediate
students
___ I have assisted at 2 full cycles of the Advanced year
___ Recommendation letters from 2 faculty members attached
GROUP CASE CONSULTATION
Group Case consultants are expected to have related teaching and/or group consultation and leadership experience in a related field.
_____ I have given a minimum of 20 individual case consultations for Advanced
students
_____ I have a minimum of 7 years of experience in active SE practice (this may include the time spent in the SE training).
_____ I agree to have a maximum of 10 participants in group case consultations
_____ I agree to receive consultation from a faculty member
By submitting this application, I am certifying that I have
read the Assistants, Approved Provider and Case Consultation Guidelines,
document date 02.22.06. I further certify that I meet the requirements stated
in these guidelines for the level of assisting or providing requested in
this application. I agree to represent the Foundation for Human Enrichment
in a professional manner at all times when assisting and working with clients.
I understand the fee structure stipulated in the agreement and agree to
adhere to these guidelines when working with participants in the SE training
program.
______________________________
Signature
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