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Certified Geek Therapist/Specialist Information Update Form
Form Instructions:
Please fill out this form to ensure your information is properly updated in the certification renewal system.
* Indicates required question
Email
*
Your email
Name
*
Your answer
Mental Health Professional License and Expiration Date (Please input N/A for CGS)
*
Your answer
Original Date of Certification for CGT/CGS
*
Your answer
CGT-Supervisor
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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