Nurturing Change
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Nurturing Change
Professional Partnership Application
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First Name
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Last Name
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Email
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Name of Organization/Practice
I am interested in the following (check all that apply):
Referring clients to Nurturing Change for TBRI trainings
Referring clients to Nurturing Change for individual TBRI coaching
Obtaining TBRI training for my organization
Providing professional services to the clients of Nurturing Change
Phone
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Organization City and State
Credentials
Services offered (Therapy, Group Home, Residential Treatment Center, TBRI coaching, TBRI parent support groups, other)
What are your fees?
Do you offer reduced rates or a sliding scale?
Have you completed the TBRI practitioner training through the KPICD at TCU?
If so, what month and year did you complete the practitioner training?
If so, did you also complete the TBRI Educator training?
If you are not a TBRI Practitioner, how many hours of training have you received in TBRI and who/what facility presented the training?
Describe your personal and professional experience utilizing TBRI.
What other trauma-related modalities have you received training in and utilize in your work? (EMDR, Circle of Security, TF-CBT, Theraplay, NMT, others?)
If you work for a residential facility (group home or RTC), what ages, genders, and levels of care does your facility serve?
If a residential facility, describe how you incorporate TBRI in your facility with your staff.
