DBT CITI PT II 2024 Attestation Form

"*" indicates required fields

Participation Statement*

I participated in the training, DBT CITI PT II with Andrew White, PhD, ABPP on the following dates April 2, 9, 16, 30, May 7, 14, 21, 28, June 4, 11, 18, 25, 2024 from 3:00pm-5:00pm PT. Please accept this as verification that I participated in the event in its entirety.

I participated in the entire DBT CITI Pt II Training

I did NOT participant every day of DBT CITI Pt II Training

If not all, please mark what dates you DID attend

April 2, 2024

April 9, 2024

April 16, 2024

April 30, 2024

May 7, 2024

May 14, 2024

May 21, 2024

May 28, 2024

June 4, 2024

June 11, 2024

June 18, 2024

June 25, 2024

Name

First Last

Profession/Discipline:

On the line below, please enter your full name and licensure, EXACTLY as you would like it to appear on your CE certificate.*

Example: Jane Doe, PhD, CADC I

Email address where you would like your CE certificate delivered.*

Can we send you information about upcoming trainings?

Yes

Signature*

By signing below, I verify that I attended this event in its entirety.

DBT Training Calendar

(NEW OFFERING) Launching a DBT Skills Group
October 31 - November 1, 2024
Leah Smart-Gordon, LCSW, DBT-LBC
Jason Fritts, LCSW, DBT-LBC
Erica Tan, PsyD, DBT-LBC

Ethics, Boundaries of Competence, Avoiding Harm, and Risk Management: Working Well with the Suicidal Patient
November 18, 2024
Andrew White, PhD, ABPP, DBT-LBC

DBT for People with Substance Use Disorders
December 4-6, 2024
Linda Dimeff, PhD, DBT-LBC
K. Michelle Peavy, PhD

(Free CE Hour) Addressing Therapy Interfering Behavior in Clinical Practice
December 11, 2024
Esme A.L. Shaller, PhD

(Exclusive Half-Day) DBT and SPACE training for Parents of Multi-Diagnostic Young Adults: Expanding on Acceptance and Change
December 13, 2024
Amy Kalasunas, LPCC-S, NCC, DBT-LBC

(Free CE Hour) Preparing Adolescents for Life Beyond Treatment: The Role of Skills Building in Residential Care and Post-Discharge Outcomes
January 8, 2025
Brad Simpson, DSW, LCSW

DBT in a Nutshell: Treating Multi-Diagnostic, Complex Individuals
January 16-17, 2025
Leah Smart-Gordon, LCSW, DBT-LBC

Maximizing Individual Therapy in DBT: Moving Beyond Life Threatening Behavior
January 30-31, 2025
Andrew White, PhD, ABPP, DBT-LBC

Dialectical Behavior Therapy for Psychosis
February 7, 2025
Maggie Mullen, LCSW, DBT-LBC, (they/them)

Diving into DBT Skills for Adolescents and Caregivers
May 15-16, 2025
Jamie Bedics, PhD

See More

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