Become a Member! "*" indicates required fields Name* First Name Last Name Work Email Address* Agency*How many years have you been with this agency*Please enter a number less than or equal to 99.Primary Role in CPP Training*SelectTherapistSupervisorSenior LeaderOtherPlease specify 'Other' role:*Do you currently hold a professional license in your mental health discipline? Yes No Which team member will serve as your supervisor?Please check to indicate that you understand the following: You must be supervised by a licensed person trained in CPP while you are taking part in the CPP Learning Collaborative Should your supervisor leave the agency, your agency must make arrangements for you to be supervised by another supervisor trained in CPP, or, at a minimum, have your new licensed supervisor join the consult calls, so they understand how CPP may influence your clinical work If you are a student trainee therapist (e.g. predoctoral intern), and you are not at an endorsed CPP internship site, you will not be eligible for the CPP roster. Years of clinical experience after receiving degree (enter '0' if not yet post-degree).What is the primary reason you are participating in this CPP Learning Collorative? You knew about CPP and wanted to get trained You were told to come by your agency Other If other, please specify:How many clients are on your caseload?How many direct service hours do you typically provide a week?If this number varies, pick the average.Select0-56-1516-2526-5050+How many of your clients are under age 6?Settings where you will be providing CPP services.*Check all that apply Community setting (community centers, library, churches, etc.) In-Home Inpatient hospital Outpatient/Clinic School Transitional housing (residential treatment program, domestic violence shelter, etc.) ExperienceDescribe your experience working with children under age 5 and their familiesDescribe your experience working with children and adults who have experienced traumaDescribe your experience working with children and adults who have experienced traumaAnything else you want us to know about your mental health training background?Anything else you want us to know about your mental health training background?How much experience have you had with CPP?How much experience have you had with CPP?
