JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
LPTI Complementary Double Feature
The Path to Psychodrama Certification
and
Psychodrama: A Cinematic History, a film by Robert Siroka
Sunday, January 30, 2022
1:00-3:00 pm, EST; 10:00 am-12:00 pm, PST
3:15-5:00 pm, EST; 12:15-2:00 pm, PST
Sign in to Google
to save your progress.
Learn more
Contact Information
What is your Name?
Your answer
What's the best phone number to reach you?
Your answer
What's the best email to reach you?
Your answer
What is your mailing address?
Your answer
Who is your emergency contact? (Name, relation)
Your answer
What is the best phone number for your emergency contact?
Your answer
Psychodrama Background
What is your current psychodrama status?
Trainee
Trainee applying for certification in the next two years
CP/PAT
TEP
Other:
Clear selection
LEARNING GOALS AND EXPECTATIONS
What is your primary reason for attending?
I like movies AND psychodrama!
I want to learn more about the certification process
It's a low-stakes community activity
Other:
Clear selection
I will likely attend... (choose both if both apply)
Part 1: The Path to Psychodrama Certification
Part 2: Psychodrama: A Cinematic History
Other:
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
