DSTT Professional Education and Training: Level 1 Application 2024

Basic Information

Name

Date of Birth

Phone Number

Website

Address

City

State

Zip Code

Country

Relevant Education

1. What is your highest level of education completed, and in what field?

Bachelor's Degree: Master's Degree: Doctoral Degree: Other:

3. Do you have specialized education, training, professional experience, and/or certification(s) related to compulsive sexual behavior, sex addiction, problematic sexual behavior, and/or infidelity? Please describe:

4. Do you have specialized education, training, professional experience, and/or certification(s) related to assessment, or the treatment of the spouse or intimate partner impacted by infidelity, or compulsive sexual behavior, sex addiction, or problematic sexual behavior? Please describe:

5. Do you have specialized education, training, professional experience, and/or certification(s) related to intimate partner abuse, psychological abuse, relationship abuse, domestic violence, and/or gender-based violence? Please describe:

6. Do you have specialized education, training, professional experience, and/or certification(s) related to human sexuality and/or clinical sexology? Please describe:

Clinical Licensure:

Note: If there is enough interest, Level 1: Illumination Series may be offered to selected professionals who can participate in a non-licensed professional track, e.g Pastors and Specialized Researchers, etc.

Are You a Licensed Mental Health Professional or Unlicensed?

Licensed Unlicensed

1. Are you currently licensed as a mental health professional in the United States, meaning you are legally able to practice psychology independently and governed by a State Licensing Board?

Yes No

2. If licensed similarly in another country, please answer accordingly:

3. Which State(s) are you licensed to practice psychology, currently?

4. How long have you been licensed as a mental health professional total?

1. Are you currently unlicensed and an intern being formally supervised by a licensed mental health professional?

Yes No

2. If so, does your supervisor know and approve of you applying for this course?

Yes No

3. If you are unlicensed, are you still interested in the possibility of taking only Level 1: The Illumination education, if it is being offered?

Yes No

4. If you are an unlicensed professional, pleased describe your educational and professional experience, training, certification(s) and any related credentials:

Professional and Clinical Experience:

1. How many clients/patients have you treated or worked with, on individual basis, where compulsive sexual behavior disorder, infidelity, problematic sexual behavior, and/or sex addiction was the presenting problem for that client/patient?

2. How many groups for clients/patients have you conducted where compulsive sexual behavior disorder, sex addiction, and/or infidelity was the presenting problem for the clients/patients?

3. How many number of years conducting groups for compulsive sexual behavior, sex addiction, problematic behavior, and/or infidelity, in total?

4. How many clients/patients have you treated or worked with, in individual therapy or individual basis, who were the identified spouse or intimate partner impacted by their partner’s compulsive sexual behavior disorder, sex addiction, and or infidelity as the presenting problem?

5. How many groups for spouses or intimate partners impacted by a partner’s compulsive sexual behavior disorder, sex addiction, problematic sexual behavior, and/or infidelity was the presenting problem, have you conducted?

6. How many number of years conducting groups specifically for the intimate partner or spouse who has been impacted by problem sexual behavior, compulsive sexual behavior disorder, sex addiction, and/or infidelity, in total?

7. How many couples or relationships have you treated or worked with total in your practice where compulsive sexual; behavior, sex addiction, problematic sexuality and/or infidelity was the primary and presenting reason for seeking treatments you?

8. Have you ever worked in a treatment center for infidelity, compulsive sexual behavior disorder, problematic sexuality and/or sex addiction? If so, when, how long, what was your role, individual or groups? and briefly describe any related experience in this context:

Types of Patients

Individual Group

Current Professional Work and Application:

9. If you are seeking to earn CE credits offered by the American Psychological Association (APA), please provide name and license number as it should appear on your Continuing Education(CE) Certificate.

10. Please briefly describe your current professional work and/or practice?

11. Berifly describe your personal motivation for participation in the course:

12. How did you hear about this professional education and training?

13. Do you require any special accommodations to access and/or participate in online courses?

Discount Offers:

Group Discount: If you have a group of 4 or more clinicians/professionals who practice in a treatment center or healthcare facility, you may qualify for a group discount.

Student Discount: If you are a clinical grad student or currently unlicensed but under the supervision of a licensed professional, you are considered a candidate to receive a 50% discount for the entire Levels 1-4.

Group Discount Student Discount

Group Name

Please enter the name of the treatment centre, health care facility, or any other relevant group name by which you may be recognised as a group, and assessed for eligibility for a group discount.

Name of Supervisor

Please provide the name of your supervisor who is a licensed professional.

Time Period under Supervision

Indicate the duration of time you have been under the supervision of the provided supervisor to qualify for the student discount.

The Institute for Sexual Health (ISH) is approved by the American Psychological Association to sponsor continuing education for psychologists. The Institute for Sexual Health maintains responsibility for this program and its content.

Please enter your Initials below:

DSTT Professional Education and Training Application 2024

Thank you for your interest in DSTT Professional Education and Training.
Your Application has been Submitted.

ISH is reviewing your application. Please look for an email from “erm@theinstituteforsexualhealth.com ” for more information regarding your application.

DSTT Professional Education and Training: Level 1 Application 2024

Basic Information

Relevant Education

Clinical Licensure:

Professional and Clinical Experience:

Current Professional Work and Application:

Discount Offers:

DSTT Professional Education and Training Application 2024

DSTT Professional Education and Training Application 2024

Thank you for your interest in DSTT Professional Education and Training.
Your Application has been Submitted.

The Institute for Sexual Health (ISH) is approved by the American Psychological Association to sponsor continuing education for psychologists. The Institute for Sexual Health maintains responsibility for this program and its content.

Resources

Resources

Inquiries

Inquiries

Newsletter

©️ Omar Minwalla, Psy.D. 2024-2025, All Rights Reserved.

Trish Haight, LMFT

Dr. Omar Minwalla, Psy.D.

DSTT Professional Education and Training: Level 1 Application 2024

Basic Information

Relevant Education

Clinical Licensure:

Professional and Clinical Experience:

Current Professional Work and Application:

Discount Offers:

DSTT Professional Education and Training Application 2024

DSTT Professional Education and Training Application 2024

Thank you for your interest in DSTT Professional Education and Training. Your Application has been Submitted.

The Institute for Sexual Health (ISH) is approved by the American Psychological Association to sponsor continuing education for psychologists. The Institute for Sexual Health maintains responsibility for this program and its content.

Resources

Resources

Inquiries

Inquiries

Newsletter

©️ Omar Minwalla, Psy.D. 2024-2025, All Rights Reserved.

Waiting List

Waiting List

Waiting List

Applications will be accepted soon!

Student Discount

Group Discount

Level 4 Applications Open May 5, 2024?

Level 1 Application and Registration Open Now

Level 3 Applications Open Oct 6, 2024

Level 1 Application and Registration Open Now

Level 2 Applications Open May 5, 2024

Level 1 Application and Registration Open Now

Trish Haight, LMFT

Dr. Omar Minwalla, Psy.D.

Professional Education and Training

Thank you for your interest in DSTT Professional Education and Training.
Your Application has been Submitted.