DBT Clinicians Applied Course Attestation Form

"*" indicates required fields

Participation Statement*
I participated in the training, DBT Clinicians Applied Course with Christopher Conley, DSW & Erica Tan, PsyD on January 8-12, 2024 from 8:30am-4:00pm PT. Please accept this as verification that I participated in the event in its entirety.
Example: Jane Doe, PhD, CADC I
I confirm the single line above contains my name and licensure exactly as I want displayed on my CE certificate.
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By signing below, I verify that I attended this event in its entirety.