Clinical Child and Pediatric Psychology Training Council (CCaPPTC) -  Member Application
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Program Name *
The sponsoring institution of higher education or training
 *
Director of Clinical Training/Training Director (DCT/TD) *
Mailing Address *
DCT/TD - E-mail Address *
DCT/TD - Phone Number *
Web address for program

Alternative Designated Program Representative (optional; i.e., if the DCT/TD is does not oversee child-focused training in the program and wishes for another party to represent the program in CCaPPTC business)

Alternative Designated Program Representative email address (optional)

Type of Training Program (please complete a separate form for each type of training)
 *
Type of training offered *
ज़रूरी
Year this training program was established *
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