Application for Approved Consultant Status

Current Status*
- I am a current member of the Parnell Institute for Attachment-Focused EMDR and will maintain my active PI AF-EMDR Certification status throughout my time as an AF-EMDR Approved Consultant
- I have completed at least 30 hours of AF-EMDR consultation-of-consultation, at least 10 of which were individual, over no less than 2 years and no more than 5 years.
- During my time as a Consultant-in-Training I attended at least two Parnell Institute Attachment-Focused trainings Parts 1 and 2 and one Part 3.
- I have attended AF-EMDR trainings on working with diverse populations
Recommendations*
- I am attaching a recommendation for Approved Consultant status from the Senior Consultant(s) who provided my consultation-of-consultation
Name of Senior Consultant(s):
Upload Your Recommendation letter*
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Licenses & Insurance*
- I hold a current license/registration/certification in my respective field of practice as a mental health professional as outlined on the PI website and observe professional standards and code of ethics.
- I have attached a copy of my current license.
- I am attaching a copy of malpractice insurance and have listed the Parnell Institute as additional insured.
Upload Your Independent Professional License (MUST INCLUDE EXPIRATION DATE) & Malpractice Insurance*
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Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.
Please upload these items:
1. Copy of your CURRENT license, certification, or the equivalent, as a mental health professional per the guidelines of your state, province, or country.

2. A copy of your malpractice insurance with Parnell Institute as an additional insured.

If you don't have a digital copy of your license, you may either scan or photograph it. Click here if you need additional instructions.

*Please make sure your file size is no larger than 10MB.
Agreements*
- I agree to keep up to date on all requirements for AF EMDR certification and to keep my consultees informed of these requirements
- I have read and agree to the Parnell Institute policies for recertification every two years.
- I have read and agree to adhere to all Parnell Institute policies and to observe the ethical and professional code of conduct of my respective clinical profession.
Name*
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Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Website

Forms

Application for Approved Consultant Status