Rolling Admissions between January – July 15. Must be submitted by July 15.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

PART I: NAME OF APPLICANT

Name:*

PART II: PRACTITIONER CERTIFICATION

PART III: STATEMENT OF PRIMARY TRAINER MENTORSHIP

I (Name of Trainer): ____________, approve and endorse that (Name of Applicant): ____________ be admitted to the Practitioner Applicant for Trainer Process (PAT). We understand that this process requires us to work together, and to schedule regular and routine consultation sessions. The PAT process requires a minimum of three years of progressively responsible training and education in psychodrama, sociometry and group psychotherapy. The PAT will: 1) Offer a minimum of 144 hours of training workshops over three to five years; 2) Receive direct consultation with the Primary Trainer: 48 hours of consultation for the first 144 hours of required training workshops and will receive a minimum ratio of 1 consultation hour to 8 training hours for training workshops offered over the minimum required number of training workshop hours; 3) Take responsibility for informing their students that workshops are offered for credit and that they can receive a maximum 160 hours of training credit from all PATS; and 4) Obtain 100 hours of Professional Development. Together we have developed a plan for the next year. Attached is a one to two page narrative of the PAT's intention to obtain professional development, offer training workshops and receive consultation over the next year. The narrative consists of three sections: I. Professional Development, II. Training Workshops, and III. Consultation. The professional development section consists of two paragraphs. The first paragraph is an assessment of the PAT's current skills, knowledge and abilities to function as a TEP. The second para‐ graph states the skills, knowledge and abilities that the PAT plans to acquire over the three years and when and where the PAT will acquire them. The second section contains the training workshops that the PAT plans to offer in the coming year including where and when they will be offered, and the topics for the workshops. The final section will be a brief description of the PAT's intentions for receiving consultation. It is the responsibility of both parties to meet with each other regularly and routinely. It is the responsibility of the PAT to keep a record of all training hours offered for credit, and the responsibility of the Primary Trainer to verify that all documents submitted to the Board are accurate.

The PAT initiation plan should include the signature of the Applicant and Primary Trainer, the date and the following statement: We have reviewed this application to enter the certification process for Trainer, Educator, Practitioner. We, the undersigned, have agreed to the training plan we have attached. We verify that all the information it contains is accurate, to the best of our knowledge. We understand that the Board of Examiners reserves the right to verify any information contained in the application.

Please upload your files below. They must be in .doc, .docx, or .pdf format.
Accepted file types: doc, docx, pdf, Max. file size: 128 MB.
MM slash DD slash YYYY

PAT Application Fee

PAT application processing fee is $225. Please be advised that the application is reviewed on a rolling basis from January 1 through July 15. Between July 16 and September 1, the PAT Initiation fee is $325 application review fee (review fee + late fee). You can pay for your application fee here: https://psychodramacertification.org/pay-now/#pat