by Tatai@Makers July 17, 2024 Title Given Name Family Name Date of Birth GenderMaleFemaleOther Preferred Pronouns Work Phone Email Preferred Mailing Address City State Country Postal Code Upload Proof of Identification Highest Art Therapy QualificationPhDPost Graduate DiplomaMasters DegreeUndergraduate DegreeDiplomaAssociate DegreeOther Training Institution (College, University) Graduating Year Program Title Location Upload Supporting Documentation I hereby declare that the documentation provided regarding this application is a true and accurate, updated record. I would like to receive correspondence from TATAI via email. Years Practicing as a Professional-Level Art Therapist1-5 years5-7 years8-10 years10-15 years15-20 years20-25 yearsOther Charges of Unprofessional ConductYesNo Criminal Charge ConvictionYesNo Currently Under InvestigationYesNo I agree to abide by the conditions laid down in TATAI's Code of Ethics. Please specify if your supervisor is from another professional field: I will be responsible for acquiring Continuing Professional Development. Job Title EmploymentPrivate OrganisationNon-Profit OrganisationSelf-employedPrivate PracticeConsultantEducational / Academic Domain (Schools/ College/ University)Corporate SectorHospitals (Public & Private)Other domains or rolesCurrently not practisingSeeking employmentOther Please articulate your professional role and delineate the scope of your professional responsibilities Therapeutic Approaches Creative Approaches Client Population GroupsEarly Childhood (Toddlers / Preschoolers - 1-8 years)Middle Childhood (9-11 years)Adolescents / Teenagers (12-17 years)Adults (18-64 years)Seniors/ Elderly (65+ years)IndividualsGroupsCouplesFamiliesMenWomenNon-binaryLGBTQIA+VeteransRefugeesIndividuals with diverse abilitiesDifferently-abled PopulationsCulturally Diverse PopulationsOther Special Expertise & Additional Information Creative & Professional Interests Research Areas Available to Take Referrals for Private PracticeYesNo Available for Consultation WorkYesNo Link to directory Current CV Additional Files Do you offer Supervision?YesNo Would You Like to Be Listed as a Supervisor?YesNo Have You Undertaken Any Form of Supervision Training?YesNo Art Therapy Supervisor Qualification * Course: Training Provider / Organization/ Institution: Course Duration: License/Certification Number: Any others, if yes, provide details: Years of Experience as a Supervisor * Completed Supervision Hours * What supervision do you offer? *Individual (in-person)Group (in-person)Online supervision (individual or group)Other: Supervision Approach * Areas of Expertise * Population groups: Availability and Preferences *YesNoDo you want to feature your supervision services as part of the TATAI Art Therapist Directory on the website? Agreement to abide by the ethical guidelines of professional supervision Please share Document/Certificate from Supervision Training: Reference 1: Full Name: Relationship: Reference 2: Full Name: Relationship: I confirm that the information provided is accurate and complete. Date of Submission: Any queries/ clarifications/ or comments: Your commitment to providing accurate and thoughtful information is highly appreciated. We look forward to welcoming you to the TATAI community. If you have any questions or concerns, please feel free to reach out on hello.teamtatai@gmail.com.
