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2004 Application San Diego Regional EMDR Basic Training in Camarillo, CA
Alicia Avila Licensed Clinical Social Worker P.C.
Lic. LCS19899 3990
4629 Cass St. #368, San Diego, CA 92109
(858) 344-9440
alicia@aliciaavila.com
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Email
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Your email
Name
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Your answer
License type/status and number
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Your answer
EMDR Practice Setting (name of agency and/or private practice) Population served
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Your answer
1. What drives you to want to get trained in EMDR at this time? What do you hope to gain from this training?
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Your answer
2. What are your concerns in entering into this training?
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Your answer
3. What would be most helpful to you in this learning process and then in implementing a new therapy approach in your particular practice setting?
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Your answer
4. What other therapy models or orientations are you using as a clinician?
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Your answer
5. What populations are you currently working with and in what setting (outpatient, residential, IOP?)
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Your answer
6. What population are you most interested in working with?
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Your answer
7. What interests you most about clinical work?
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Your answer
8. Other past clinical experience (i.e.; populations served, clinical orientation/types of interventions used).
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Your answer
9. Years of clinical experience (including pre-licensed)
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0-1
2-3
4-9
10+
9. What can you tell me about your learning style?
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Your answer
Consultation groups will be 2 hours approx.. once per month. It will require that you modify your schedule to make this meeting. Not all of these options will be available but I will do my best to accommodate your preference. Please indicate your preference.
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Mon 9-11am
Mon 11:00-1pm
Tues 9-11am
Tues 11-1pm
Wed 9-11am
Friday 9-11am
Required
Your LEAST preferred consultation group time:
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Mon 9-11am
Mon 11-1pm
Tues 9-11am
Tues 11-1pm
Wed 9-11am
Friday 9-11am
Required
It is recommended that you work with someone you do not know in the afternoon practice due to potential conflict of interests and confidentiality. If you know of someone else attending this training please let me know now so that I can put you in separate groups. If you only find out on the first day of training please text me that morning so that I can modify the afternoon groups. You can text me at (858)344-9440. Let me know if you have any requests regarding the small group practice.
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