My Account
Cart
Checkout

Give us a call now: (913) 735-0396

Trainings
Supervision
Products
- Products
- Supervision Documents
About
Therapy
Contact
Search
Menu Menu

0Shopping Cart

Heartland Play Therapy Certificate Program Application

Applicant Information
Certificate Program Desired*
Select the certificate program at the location you would like to attend
Name*
First Last
Preferred Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Phone
Employer
Status
- Student (If yes, attach current proof of enrollment)
- Professional
Do you require any accommodations for a disability?
- Yes
- No
Please describe your disability and needs here
Mental Health Experience
Are you currently licensed in a mental health field?
- Yes
- No
What license(s) do you hold:
Do you currently work in the mental health field?*
- Yes
- No
Do you see children or families in your practice currently?
- Yes
- No
Play Therapy Training & Experience
Have you had previous play therapy training?
- Yes
- No
List
Workshop Title Sponsor/Facilitator Date Attended Training Hours APT Approved (yes or no)
Program Components
Please mark the components in which you are interested in participating:
Programs & Workshops*
Partial Program Worshops
Multiple workshops to complete 150 training hours -- use the CTRL/Command key to select more than one:
Who referred you to our program?
Sign-me up for the free newsletter
- Sign me up for the free newsletter to stay up-to-date with our upcoming workshops!

Δ

Certificate Programs with Open Enrollment

75 + Supervision
Price range: $2,750.00 through $5,275.00 Sale!
Cancellation/Reschedule Fee – $25
$25.00
Cancellation/Reschedule Fee – $50
$50.00
Cancellation/Reschedule Fee – $75
$75.00
Certificate Replacement Fee – $10
$10.00

Kansas City

6701 W. 64th Street
Suite 110
Overland Park, Kansas 66202

HeartlandPTI@gmail.com
(913) 735-0396

Des Moines

Community Support Advocates
1516 Valley West Drive
West Des Moines, IA 50266

HeartlandPTI@gmail.com
(913) 735-0396

Omaha

Project Harmony
11949 Q Street
Omaha, NE 68137

HeartlandPTI@gmail.com
(913) 735-0396

St. Louis

Lutheran Family & Children’s Services
9666 Olive Blvd., Suite #400
St. Louis, MO 63132

HeartlandPTI@gmail.com
(913) 735-0396

Wichita

Friends University
2100 West University Street
Wichita, KS 67213

HeartlandPTI@gmail.com
(913) 735-0396

© Copyright Heartland Play Therapy Institute, Inc. All Rights Reserved