20 Washington Ave. Suite 108
North Haven, CT 06473
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*Address (street, city, state, zip):
Describe your organization (school system, private practice, state
agency, rehab center) types of clients you work with, and any associates
who will assist you in conducting the AIT listening sessions:
Highest Educational Level Achieved:
List current degrees, professional licenses and enclose copies of
all certificates, diplomas, licenses, etc. Include Date, Degree, University/College,
Field of Study:
List past five years of related professional work experience, starting
with the most current:
Have you had previous experience with any type of sound interventions?
List related non-professional experience, starting with the most
Professional Associations to which you belong:
CEU's: Are you interested in obtaining CEU's?
A certificate of completion for CEU's can be provided for you to
turn in to your local agency. Pre-approval is often required, so be
sure to check on this.
List Date of Professional Training Seminar you wish to attend:
To the best of my knowledge, the information above is correct.