Please fill out and fax this form to +207-865-1213 or email it to Phoebe Prosky at:   pprosky@suscom-maine.net.

APPLICATION for TRAVELING TRAINERS

IFTA TRAINING DIVISION

Name:

Address:

Phone:

Fax:

E-mail:

Please state your family therapy training experience:




Please list the countries in which you have done family therapy training:


Please give the names of two organizations for which you have provided training and the names and contact information of people who could provide references for you.






Please list the content areas in which you would like to provide training:






Please list the languages in which you can provide training:


Please note any restrictions or preferences with regard to travel times or places: