Registration Form

KC Play heads to Nicaragua this week. Puppets visit Central America! (2 months ago)

Kansas City Play Therapy Institute , LLC

A center for healing children & families
8015 Santa Fe Dr
Overland Park, KS 66204
(913) 406-3059
email: Denise Filley, Director

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Application to the PLAYTALK® KC Play Therapy Certificate Program

Please allow 3-4 weeks for review of application.
Referred By:
  1. Please indicate if one of the following applies to you: (special rates apply!)
1. Select a Program
  1. Kansas City
  3. St Louis
  5. Wichita
  7. Omaha
  9. Arkansas
2. Applicant Information
  1. (required)
  2. (required)
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  6. (required)
  7. (required)
  8. (required)
  9. (required)
  10. (required)
  13. (required)
  14. (valid email required)
  15. Gender (optional)
3. Employment Information
4. Mental Health Experience
  1. Are you currently licensed in a mental health field?
  6. Do you currently work in the mental health field?
  8. Do you see children or families in your practice or school currently?
  10. List any experiences in a mental health related field
    (internship, volunteer, or work experience) in the past five years.
5. Play Therapy Training & Experience
  1. Have you had previous play therapy training?
  3. If yes, Please list ALL Play therapy trainings, date attended, hours received, who sponsored and their APT provider #:
  46. If you are uncertain if a training will count towards APT requirements you can contact APT for clarification.
    Go to www.a4pt.org
  47. Have you previously received play therapy supervision?
  49. If yes, was it done by an RPT-S?
6. Program Components
7. Education
  1. List below all colleges and universities attended
  19. You will need to provide a copy of your license(s) to us and have a copy of your transcripts sent to us from your school, graduate and undergraduate. It does not have to be an official transcript.
8. Personal References
9. Submit my Application
 

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