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Therapist Enrollment in CareForTheTroops

Thank you for voluntarily considering enrollment with CareForTheTroops.

The process is simple. Fill in all the information below and click on either the SUBMIT button located at top or bottom of the form.

We will check your input for completeness and format accuracy. Error messages will appear and direct to where there are problems with the information provided. Once all is corrected, there are a couple of more steps explained in detail below the Enrollment Form.

NOTE THE FOLLOWING: - We are only accepting Georgia enrollments currently

  1. Items marked with an * on the FORM below indicate required information.
  2. Consider your enrollment and sending us this information as being on a voluntary basis.
  3. We will give preference and priority when listing therapists on the website to those who have received training in the Military Culture and trauma treatment techniques such as but not limited to EMDR, who have served in the military, and have background and experience working with the Military and their extended family members. That is consistent with the Mission and Goals of CareForTheTroops. This information is covered in questions 23 and 24.
  4. We ask for your license information for internal CFTT use only. It will not be displayed to the public in your listing information.
  5. If you wish to see an example of the information layout and what information is shown, click HERE.
  6. Our DISCLAIMERS can be read on the Legal Page of this web site.

Contact Information
1
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2
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3
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Office Locations (at least one location must be specified)
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Company Name
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*Address Ln 1
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Address Ln 2
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*City
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*State
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*Zip
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*County Name
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*Office Phone
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Office Fax
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License Info (at least one license needs to be specified; up to 3 accepted)Lic # NOT DISPLAYED on the web
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*License No
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*Profession ID
 Make selection Make selection Make selection
16
*License State
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17
*Expire Date (use dashes)
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Can You Practice In Any Additional Languages?
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Languages:
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Additional Professional Information
19
Specify Degrees Held:
*Bachelors
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Masters
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Doctorate
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Divinity
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(do not use <>[]{} quotes)
Other
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20
What Insurance Panels do you wish to list?
  (do not use <>[]{} quotes)
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Please Place a Check next to any or all the specialties you offer ( * at least one must be checked * )
21
 
 
 
 
 
 
 
22
Describe any other specialities you may have that are not indicated in the list above. (do not use <>[]{} quotes)

Can be used to describe the extent of training e.g EMDR Trained but not Certified; EMDR Approved Consultant; LMFT Approved Supervisor; CCADC Certified Clinical Alcohol and Drug Counselor
  Exceeded maximum number of characters.

Please Volunteer information regarding your training and background in the Military Culture which you offer to prospective clients by indicating if you have attended or have experience in any of the listed items.
23
Code
Military Culture Descriptions: Includes Training-Based and Experience-Based
Yes or No
Date Attended
City
 
all010
Alliant Univ On-Line Training, Military Culture
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
all020
Alliant Univ On-Line Training, PTSD Post Traumatic Stress Disorder
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
all030
Alliant Univ On-Line Training, TBI Traumatic Brain Injury
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
all040
Alliant Univ On-Line Training, Benefits
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
cft010
CFTT~Military Culture 101 Basic
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
cft020
CFTT~Military Culture 201 Advanced
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
esl010
Essential Learning~Military Cultural Competence
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
mce010
Military Child Education Coalition Gurard Reserve Inst
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
mce020
Military Child Education Coalition Transition Counselor Inst
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
mce030
Military Child Education Coalition Lining in the New Normal Inst
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
med010
MEDSpdn~John Mundt, PTSD in the New Generation of Combat Vets
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
mft010
AAMFT Inst09~Blaine Everson, Systems Therapy for Military Families
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
mft020
AAMFT Inst10~Lance Sneath, Treating Miitary Families
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
pes010
PESI~Alison Lighthall, Coming Home, Combat Stress & Trauma
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
pes020
PESI~Linda Schupp, Trauma, PTSD & Grief
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
pes030
PESI~Mark Hirschfeld, PTSD, Combat Stress, Depression & Other MHI
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
sga010
Military OneSource & St of GA Paving The Way Home Conference
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
sga020
St of GA Front Lines to Front Lawns Conference
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
va0010
VA Veterans Administration PTSD101 On-Line Training Courses
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
vhg010
VHGs~Ed Tick, War And The Soul Training
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
vhg020
VHGs~War Related PTSD Workshop
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
vhg030
VHGs-Our Turn to Serve Workshop
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
vhg040
VHGs-Pilgrimage & Poetry and Creating a Village
 Please select an item. 10 charsyyyy-mm-dd(yyyy-mm-dd)
 
exp010
Military Chaplain~current or former
 Please select an item.
 
exp013
Military Spouse~current or former
 Please select an item.
 
exp016
Military Dependent~current or former
 Please select an item.
 
exp020
Vietnam Era
 Please select an item.
 
exp030
Grenada~Urgent Fury~Era
 Please select an item.
 
exp040
Panama~Just Cause~Era
 Please select an item.
 
exp050
1st Gulf War~Desert Shield/Storm~Era
 Please select an item.
 
exp060
Iraqi~Ops Southern Watch~Era
 Please select an item.
 
exp070
Somalia~Ops Restore Hope~Era
 Please select an item.
 
exp080
Haiti~Ops Restore Democracy~Era
 Please select an item.
 
exp090
Bosnia~Joint Endeavor/Guard~Era
 Please select an item.
 
exp100
OEF Era
 Please select an item.
 
exp110
OIF Era
 Please select an item.
24
Describe any other background or training related to your understanding of the Military Culture not covered in the list above.
  (do not use <>[]{} quotes)
  Too Many characters.
25
Do you accept the terms and conditions for enrollment with the CareForTheTroops Organization? (click HERE if you wish to review the Terms and Condidtions.)
 Please make a selection.
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One last request. Please provide a USERID and PASSWORD that you wish to use. It will be needed for you to re-access and change any of the information just entered.
 16 Chars AllowedMust enter an ID
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up to 16 Chars - Min of 4 Chars
16 Chars Allowed

Here are the additional steps to expect referred to at the top of this web page.

  1. We will send you an email showing you the information you have voluntarily entered so you can check it for accuracy. If you find any errors you can come back to the website and make the changes yourself using the USERID and PASSWORD that you just created during this enrollment process.
  2. If this should be necessary, you should click on the CHANGE YOUR CFTT INFO menu option in the top of the page menu list, enter the USERID and PASSWORD where you will then be presented with the information you last entered.
  3. Next we will validate the appropriate information you have entered with your State licensing organization and others as may be needed. That should take a week or two. Once completed, we will either let you know what clarifications are required to satisfy our enrollment requirements or inform you that we have posted most of what you have provided us so that prospective clients and referral sources who come to this website can see your information.
  4. The names we list are organized by region and county based on your office locations. We also give preference and priority to those that have taken time for training in the Military Culture, have served in the Military, and have background and experience working with the Military and their extended family members.
  5. If you wish to see an example of the information layout and what information is shown, click HERE.
  6. Our DISCLAIMERS can be read on the Legal Page of this web site.

If you have not received an email within two weeks or you have any questions, please contact us using the information shown on our CONTACT US webpage page. We apologize in advance for any inconvenience if this occurs.