Contact Information Change

Are you a Children’s Trauma Initiative (CTI) trained TF-CBT or CPP therapist or a Caregiver Education, Parent or Clinical Facilitator who would like to update your contact information? Maybe you have moved to a new agency, received a promotion, or changed your name?

Complete this form to update your contact information with the Children’s Trauma Initiative.

First Name: *

Last Name: *

Previous Name (if applicable):

Current Agency Name: *

Previous Agency Name (if applicable):

Cohort Name/Number:

Work Email: *

Change in Role at Agency:

Did your position change at your agency (i.e. clinician promoted to supervisor, etc.)?

Other Updates:

Please add any additional details you think we should know.

I previously completed a learning collaborative through the Children’s Trauma Initiative.

I am currently employed at a Community Mental Health Services Program (either a Community Mental Health or its provider agency) and/or I currently provide TF-CBT or CPP with fidelity to children, youth, and families who are served through Medicaid or a Medicaid Health Plan.

I have continued including either TF-CBT or CPP with fidelity in my ongoing work with children and families.