Registration Request: STARRSA CBT Training

Name *

First

Last

Email *

Your Title *

Your Institution *

Please identify the postsecondary institution where you are currently employed or the institution you are partnering with for purposes of this training.

Are you a mental health professional or a graduate student in training to become one? *

Which type of licensure do you maintain, if any? *

have that to

Would you like to receive CE credit for this training? *

Do you have any questions going into this training that we can help answer beforehand?

Acknowledgement

As a Participant in the upcoming STARRSA Cognitive Behavioral Treatment Training (“Training”), I understand that I am not required to implement any strategies, approaches, or suggestions made during the Training as part of my role at the postsecondary institution where I am currently employed or in connection with my provision of the STARRSA CBT Program to a partnering institution of higher education within my area of geographic licensure (the “Institution”). To the extent I choose to implement the STARRSA CBT Program at my Institution following this Training, I do so voluntarily and with no guarantee regarding the effectiveness of the interventions generally or with respect to specific students. As a Participant, I further understand that student participation in the STARRSA CBT Program is optimally facilitated under voluntary conditions and that it is my responsibility to consult with legal counsel at my Institution, as needed, before implementing any strategies, approaches, or suggestions made during the Training or related to the STARRSA CBT Program.

If I choose to utilize STARRSA materials after the Training, I understand that it is my responsibility to do so in a manner that complies with applicable policy at my Institution and in accordance with all local, state, and federal law. I also understand the Training to be provided is not a “Train the Trainer” program and is not intended to prepare me to train others on the use or implementation of the STARRSA CBT Program. It is intended exclusively for individuals currently employed at postsecondary institutions who wish to facilitate the STARRSA CBT Program for students at their current Institution or a Partnering Institution. I understand the Training is being provided to me for informational and educational purposes only, with no implied or express warranties of any kind, and subject to terms and conditions which acknowledge that I shall hold Klancy Street harmless for any future use or implementation of the STARRSA CBT Program which I choose to undertake at my Institution.

I understand and agree to the terms and conditions outlined above. *

I agree

Conference Registration *

Price: $695.00

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Total

$0.00

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Refund Policy

We want you to be happy with your selection and the dates you’ve chosen! If something comes up and you’d like a refund, just let us know at least 24 hours prior to the event. We’d be happy to help you reschedule to a different session or provide a refund. All refund requests are subject to a $25 cancellation fee to cover administrative costs and credit card processing fees.