Forms

CIT DECLARATION FORM FOR PARNELL INSTITUTE

This form is for PI administrator for application process on line:

Name(Required)

First Last

Email(Required)

Yes I am AF-EMDR Certified.

Please check to confirm

Date of Certification:(Required)

NAME(s) of AF-EMDR Senior Consultant you will be working with:(Required)

CONSENT:(Required)

As an AF-EMDR Consultant in Training (CIT): I agree to maintain active status as a Certified Therapist and understand that I must maintain my Certification credential to be an AF-EMDR Consultant in Training (CIT). If my Certification credential expires, I understand that my CIT status will no longer be valid. I agree to provide the names of the EMDR Consultants I am working with as a CIT to The Parnell Institute. I understand that, once I declare my CIT status, I have 5 years to complete the requirements and become an EMDR Consultant.