PO Box 750 • Watsonville, CA • 95077
Tel (831) 761-1040 • FAX (831) 761-1204

Please read the following in its entirety and sign 

The undersigned acknowledges that they have been advised and understand the following:

• AUDIO/VIDEO RECORDING ANY PART OF THE VIRTUAL TRAINING IS STRICTLY PROHIBITED.
• To be compliant with HIPAA requirements, virtual backgrounds are not allowed during any part of the all-day training.
• Participants must complete the entire virtual training (including 10 hours of case consultation) within 12 months, from the initial start, to receive a Certificate of Completion.
• Current research is limited to the applications of EMDR to trauma-related disorders.
• Cancellation and transfer fees apply (see below)

PARTICIPANT REQUIREMENTS

• All participants must be licensed in the mental health field.
• If not licensed, have completed masters level coursework, are currently on a licensing track, and supervised by a licensed clinician with the appropriate letter on file.
• A signed letter from the licensed, supervising clinician, including his/her license number, must be submitted to the EMDR office stating “I supervise the clinical work of (your name).” An email will be sent to the participant with a link to complete this step electronically.  (submit prior to W1 training only)

AFTERNOON PRACTICUM EXERCISES

• Participants must attend the entire 2-part training and participate in the practice exercises on all 3 days.
• Clinicians will give and receive EMDR therapy under small group supervision.
• The practice experience is for educational purposes only and not for personal therapy.
• Case material presented didactically or on video/DVD may be disturbing to those with unresolved personal issues.
• Participants presently engaged in personal therapy should seek permission from their therapist before participating in this training
• Participants who presently have a dissociative disorder should not participate without special arrangements being made with the EMDR Institute office.
• Participants with limiting or special medical conditions (for example, pregnancy, heart condition, ocular difficulties) should consult their medical professionals before participating.
• A target memory could be linked to unexpected, disturbing material or memories.
• Since the processing of targeted incidents may continue after the training, other dreams, memories, etc., may surface. In such cases, it is the responsibility of the participant to seek and obtain appropriate assistance. Providing such assistance is not an extension of the training.
• Clinicians who wish to continue with personal EMDR work can request referral information from the EMDR Institute office.
• These experiential workshops (Weekend 1 and Weekend 2) are for clinical and research purposes only and will not qualify the participant to train others in EMDR.

CASE CONSULTATION

• A total of 10 hours of case consultation (5 after Weekend 1; 5 after Weekend 2) are required before a certificate of completion will be issued.
• Consultation is about actual client cases and not experiences that occur in practicum.
• To be admitted to Weekend 2 of the training, documentation showing completion of 5 consultation hours with an EMDR Institute approved facilitator/EMDRIA consultant is required (list available on EMDR.com.  Consultation Sign Off Form will be emailed to participants following training, and is included in the manual. 

CERTIFICATES

• Continuing Education (CE) certificates will be issued following completion of each 3-day training. Continuing Education (CE) certificates for 20 credits will be issued upon completion of training for Weekend 1 and another for Weekend 2. Both require a passing grade on quizzes following each event.
• A Certificate of Completion will be issued only to those who complete both Weekend 1 and Weekend 2 trainings and have completed 10 hours of case consultation with an EMDR Institute approved facilitator/EMDRIA consultant.  (Hours completed with a consultant who is not on the Institute facilitator list will not be accepted.)

WEBSITE REFERRAL LISTING

Once the Certificate of Completion has been issued, participants will be added to the EMDR Institute online referral listing. Please indicate below if we have your permission to list your name, city, state, zip code, and business phone number.

Add me to the Online Referral Listing YesNo

This Participant’s Agreement will apply for both W1 and W2 trainings

Terms & Conditions: (call the office to arrange)

• 21+ days prior to training date: $75 fee to transfer or cancel
• 20-1 days prior to training date: $100 fee; transfer only, no refund
• Day of / no show: $150 fee; transfer only, no refund