Application form for UW certificate program:
Psychological Trauma: Effective Treatment and Practice
Autumn 2008 (Program ID# 2880)

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Return to program description

To apply, please print, complete and mail this form with your required materials to the appropriate address below.

The 2008 program begins in October 2008. Applications are now being accepted and will be reviewed in the order they are received from June 2-August 22, 2008. After August 22, applications may be considered on a space-available basis, and applicants are encouraged to call 206-685-8936 or e-mail us to inquire about space availability.

I wish to apply to the UW Certificate Program in Psychological Trauma: Effective Treatment and Practice. I enclose this completed form with a nonrefundable $50 certificate program fee and two copies each of my résumé, letter of application and two letters of reference.

It is the applicant's responsibility to make sure that all required materials are submitted with the application. All applicants will be evaluated on the basis of materials submitted.

Mr.    Ms.
Last name:
First name/middle initial:
Social Security # (required):
Date of birth:
Mailing address:
City/State/Zip:
Daytime phone:
E-mail address:

Method of payment:

	Check in U.S. funds made payable to the University of Washington. (Returned checks are subject to a $25 service fee.)
	Third-party payer: separate document (purchase order or letter of authorization to bill) must accompany this application.
	VISA
	MasterCard

Card number:
Expiration date:
Name as it appears on card:
Credit card billing address:
City/State/ZIP
Signature: