Visiting Professional program Request or Consideration
Feel free to cut and past your vita to this form. Please note that all narrative fields are limited to 500 characters.

Additionally, attach a Microsoft Word electronic version of your vita to an email and send to dkinney@salesmanshipclub.org. If you have authored any professional articles or book chapters that would inform our review process (English only, please), you may also attach Microsoft Word or Adobe Acrobat electronic versions of the manuscripts (no more than two, please) to an email and send to dkinney@salesmanshipclub.org as well.

Name:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone Number:
Email Address:

List degrees awarded/universities attended.

Describe training received.

List credentials.

List titles of workshops you have presented.

List articles, chapters, or books you have written.

What about SCYFC, the Reunion Institute, and the VP Program appeals to you?

What models, theories, or philosophies have the greatest influence on the way you think?

What models, theories, or philosophies guide your clinical work/research/teaching?

How are you creative in your clinical work/research/teaching?

What are a few of your strengths as a mental health professional?

What are your expectations concerning the VP Program?

If you participated in the VP Program, how would you hope to spend your time with us?

If you participated in the VP Program, what would you hope to take back with you to your professional setting (therapy practice, university, agency, etc.)?

Please Rate Your Fluency

English–conversational

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Spanish–conversational (optional)

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