Application Form For Couples Therapy Certification

This is a Level 2, practice-based certification. Please answer honestly and thoughtfully. Your responses help us create a safe, rigorous learning space for everyone.

First name

Last name

Phone

Where are you based out of?

What is your highest qualification?

How long have you been practicing with couples for (please mention years/months)?

Have you completed level 1 with us? If no, where have you received prior training or exposure to couples therapy? (You may mention courses, workshops, supervision, or learning through practice.)

What makes you apply to this certification?

What do you find most challenging about working with couples (or what do you anticipate will be challenging)?

Are you able to commit to the full duration of the program (April–May), including live sessions, co-learning, and supervision?

Yes

Maybe (recordings will be provided too)

Please tick what's applicable

You have atleast 1 active couple client

You want us to provide you with an active couple client at a minimal fee

Please tick what applicable

I am okay with the fees

I'd like to avail the installment option

When would you prefer classes to happen?