SA Certification Application Form

The Separation Anxiety Certification Program is an intensive and rewarding program, though it is certainly not for everyone. Participants will be hand selected from numerous applicants. Upon successful graduation of the program, graduates will be listed on our website as Certified Separation Anxiety Trainers and as such, we are quite selective about the people we admit into the program. The questionnaire listed below will begin the interview process for admittance into the program.

Please provide sufficient information about yourself so that we feel we have enough information to begin the selection process. You will receive confirmation that we received your application and we will let you know that things are pending and for which program you may be eligible. Due to the overwhelming response to our Certification Program there is a considerable wait list, so please don’t expect to get into the first program or two. Programs will be offered 2 – 3 times per year.
The cost of the program is payable in full 30 days prior to the first day of the program via check. Non US participants may need to issue a bank transfer. If you require a payment plan, we can split the cost into four payments, however the balance must still be paid 30 days prior to the beginning of the program.

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Please answer the following questions:

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Give an example of a training situation in which you would use the following: (Maximum 500 characters each) :

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(We will not contact this individual until we have confirmed with you that it is okay.)