2023 Application San Diego Regional EMDR Basic Training
Alicia Avila Licensed Clinical Social Worker P.C.
Lic. LCS19899 3990
Old town Ave., Suite C203, San Diego, CA 92110
(858) 344-9440
alicia@aliciaavila.com
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Email *
Name *
License type/status and number *
EMDR Practice Setting (name of agency or private practice) *
1.  What drives you to want to get trained in EMDR at this time?   What do you hope to gain from this training? *
2.  What are your concerns in entering into this training?   *
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? *
4.  What other therapy models or orientations are you using as a clinician? *
5.  What populations are you currently working with and in what setting (outpatient, residential, IOP?) *
6.  What population are you most interested in working with?   *
7.  What interests you most about clinical work? *
8.  Other past clinical experience (i.e.; populations served, clinical orientation/types of interventions used). *
Consultation groups will be 2 hours approx.. once per month.   Please indicate your scheduling preference. *
Required
For the 2hour consultation, if it is a morning meeting do you prefer *
Consultation groups will be 2 hours approx.. once per month.   Please indicate your Least prefered time slot. *
Required
Would be available for a consultation meeting over Memorial day weekend? *
Let me know of dates that you would NOT be for those 2 hour consultation meetings Feb-May 31st *
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 *
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