MiCBT MiCBT Certification Application

MiCBT Certification Assessment Application

Certification Assessment Application Form

The following steps are to be completed BEFORE you apply for certification assessment

Our certification program is designed to encourage excellence in MiCBT. MiCBT Certification is evidence of your expertise in the use of MICBT in therapy.
When you embark on MiCBT Certification, you undertake training to improve and refine your skills in MiCBT to the highest level.

1. Complete the following core MiCBT Institute courses:
- MiCBT Foundation Course
- MiCBT Applied Course

2. Complete 12 individual supervision/mentorship sessions

3. Complete 6 MiCBT Masterclasses

4. Attend 1 MiCBT-Institute 5-Day Mindfulness Meditation Retreat

5. Attest to the following:
- I have implemented MiCBT with 8 individual clients OR I have implemented MiCBT with 2 individual clients and 2 groups
- I have implement MiCBT with at least 1 complex client
- I have completed 12 individual supervision/mentorship sessions

Cards Accepted

Card Number

Expires On

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Contact Information

We require an email address and phone number so we can communicate with you about your application. We never share this information with anyone else. Privacy Policy

First Name	Last Name
Email Address	Phone Number
Profession * I confirm that I am a registered and currently practising mental health professional

Workplace

Company/Workplace
Street Address
City	State	Zipcode/Postcode
Country *

Checklist

Please confirm by checking the boxes that you have completed the required conditions for certification

I have implemented MiCBT with 1 complex client and *

Supervision Checklist *
I have completed 12 individual supervision/mentorship sessions

Name of supervisors and supervision dates *

Masterclass Checklist *
I have completed minimum 6 MiCBT Masterclasses

Completed Masterclasses *

Retreat Checklist *
I have attended a 5-day Mindfulness Residential Retreat

Date, venue and name of teacher *

Billing Address

Your billing address must match the address on your credit card statement or your credit card may be declined.

Country
Street Address
City	State	Zipcode/Postcode

Payment Information

Certification Fee is $AUD 390. This includes administration and handling fee AUD$90
and assessment fee AUD$300.

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Your credit card will be charged $