Advanced Learning Certificate Application

Some required information is missing. Please refer to the fields outlined in red to complete the form.

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Personal Information:

First Name*

Last Name*

Preferred Name

Phone*

Email*

Street Address*

Street Address Line 2

City*

State*

Zip*

Country*

Undergraduate Degrees (Up to 2):

Undergraduate Degree

Undergraduate Institution

Graduation Year

+ Add another degree

Undergraduate Degree

Undergraduate Institution

Graduation Year

Do you hold a master’s degree in a mental health-related field from an accredited university?*

Please note that only applicants who hold a master’s degree in a mental health-related field from an accredited university will be considered for admittance into this certificate program. You must list your relevant required degrees below.

Graduate Degrees (Up to 3):

Graduate Degree

Graduate Institution

Graduation Year

+ Add another Graduate Degree

Graduate Degree

Graduate Institution

Graduation Year

Statement of Purpose*

Upload Resume*

Optional: Letters of Recommendation (Up to 3)

How did you hear about us?*

If Other, Please Specify*