Small Group Case Consult Provider Application Header Image

Small Group Case Consult Provider Application

Small Group Case Consultation Providers take on an expanded leadership and educational role within the SE™ community. Group case consultations include elements of the teaching function, so special attention has been given to establishing criteria at this level of approval. Those approved for small group case consults will be on the SE Faculty Track or will have significant related teaching or group consultation experience. Assisting at SE Professional Trainings and providing individual case consultations are not considered sufficient experience to qualify as an SE small group case consult provider.

 Case consultation groups are intended for review of SE course material and consultation about clients with whom the SE student/SEP is working. Approval as a small Group Case Consultation Provider does not authorize the provider to make actual presentations of SE material or to otherwise engage in teaching SE methods.

 We appreciate the service that our approved case consultation providers offer to our students. We understand that providers also benefit professionally and financially from offering these sessions. Please note, however, that being a case consultation provider should not be considered a career path. We cannot guarantee that providers will progress through the provider levels or maintain approval to provide credited sessions/consults after receiving initial approval. Please be sure you have read and understood our Group Case Consult Provider Guidelines.

Completing this application will take about 20 minutes. Please note that you will be required to upload your curriculum vitae(cv) or resume and faculty recommendations during this application process. In addition to this application, you are also required to sign the Provider Informed Consent & Release Agreement. You will be given a link to the agreement in the application.

Please make sure all required documents are included. Incomplete applications will cause a delay in processing. Once your application has been submitted you will receive a confirmation email. If you do not receive this confirmation email, please contact the Assisting Team.

Please allow up to 4 weeks for your application to be processed. Once approved, you will receive a letter via email authorizing you to provide Individual Consultations at the level of your application and approval.  This letter may be presented to your local organizer, lead assistant or faculty member as proof of your authorization. 

If you have questions, please visit our FAQs. If you have additional questions or need further support with your application, please schedule an Assistant and Provider Graduate Services Appointment from the Contact Page of our website.  

Before starting the application, make sure you have:

  • CV/Resume
  • 2 Faculty Recommendation Forms
  • Signed the Provider Informed Consent Agreement

Interested in Assisting or Providing with our International Partners?

Click here to open a new window and view additional information.

Applicant Information

Name*
Address*

Consent Agreement

Provider Informed Consent Agreement: 

Click the link to sign the agreement. The agreement will only need to be signed once by each individual applicant and will be applicable for approval to provide personal sessions, and individual or group case consults. You will be directed away from the application to sign. Please return to complete application submission.

Provider Requirements

Do you have any grievances, complaints or actions filed, pending or upheld against you for misconduct of any kind as a professional before any licensing, regulating, associative, or legal body?*

(Even if you have already reported this to SEI, please mark "yes" if it applies.)

Have you already provided the required information to SEI's Legal Department?*

PENDING STATUS

Based on your response you are not eligible for approval at this time and your request will be immediately placed in a pending status upon receipt. Please email legal@traumahealing.org to provide additional information on this matter and for directions on how to proceed.

I meet at least ONE of these 4 criteria: (If you meet one of the top three criteria listed below, you will automatically receive individual case consultation approval for each level you receive small group case consultation approval.)*

Provider Level

Beginner Level

Intermediate Level

Advanced Level

Stop

STOP


Based on your selection you may not proceed with this application. Contact us for instructions on how to proceed.

Confirmation of Ethics and Licensure

I understand and agree that I may only provide credited case consults to students at the appropriate levels. I will not provide consultations above my approval level, and I will provide consultations at the current level of the group of SE students with whom I am consulting.*
I agree that scholarship students will be charged a maximum of $75/Credit hour (3hrs=1 Credit hour) for any credited Group Consultations I provide counting toward the minimum SEP certificate requirement that are noted on a session log.*
As a case consultant, I understand that it is strongly recommended that I receive at least 4 consultations per year with a SE Faculty member or an approved small group case consultant, and that at least 2 of these consultations should be used to request feedback on consultations I am providing.*
I understand the limits of my scope of practice within my primary modality and license, and can clearly articulate them to students who consult with me. I agree to adequately guide students towards more appropriate professional consultation if the issues that arise are outside my scope of practice.*
I understand the common professional ethics and confidentiality rules associated with my practice modality and license.*
I agree to articulate these rules to SE students or SE providers who consult with me.*
I agree to allow these rules to to guide me in deciding if an ethical or confidentiality issue raised in case consults I provide are beyond my scope of practice.*
I agree to allow these rules to guide me in deciding if an ethical or confidentiality issue raised in case consults I provide are better addressed by another professional consultant.*
I agree that I will at all times maintain and fully fund comprehensive professional liability and malpractice insurance with appropriate coverage amounts in accordance with the regulations of the country/region where I am providing sessions and/or consults.*
I agree that I will at all times be a fully paid and up-to-date member of a professional association maintaining an industry-standard code of ethics, AND/OR I will at all times maintain a fully paid and up-to-date professional license with an applicable regulatory agency.*
I agree that I will be solely and exclusively liable for all sessions, meetings, and consultations with SE students under any and all conditions including, but not limited to, at an SE Professional Training event, through my private practice, and at an unaffiliated location.*
I will at all times indemnify and hold harmless Somatic Experiencing International, its offices, directors, agents, successors and assigns from and against any and all claims, actions, damages, costs and expenses (including reasonable attorney fees) related to my acts or omissions in providing services to SE students.*

Provider Documents

Upload your EASE/ABT Approval here, preferably in PDF format. *
No File Chosen
File uploads may not work on some mobile devices.
Please upload your resume or CV, preferably in PDF format.*
No File Chosen
File uploads may not work on some mobile devices.
Please upload a Small Group Case Consultation Recommendation Form from a SE Faculty Member for this level, preferably in PDF format. (Two recommendations are required.)*
No File Chosen
File uploads may not work on some mobile devices.
Please upload a second Small Group Case Consultation Recommendation Form from a SE Faculty Member for this level, preferably in PDF format.*
No File Chosen
File uploads may not work on some mobile devices.
Please submit your SEP Certificate of Completion.*
No File Chosen
File uploads may not work on some mobile devices.
In order to qualify to be an assistant or provider you are required to be an SEP.

Other Information

Please list all languages in which you feel comfortable working.*

Agreements

Please make sure all required documents are included. Incomplete applications will cause a delay in processing.

If you have questions, Please visit our FAQs. If you cannot find answers to your questions there, you may schedule an Assistant and Provider Graduate Services Appointment from the Contact Page of our website.

Please allow up to 4 weeks for your application to be processed. Once approved, you will receive a letter via email authorizing you to assist or provide sessions at the level for which you have applied. This letter may be presented to your local organizer, lead assistant or faculty member as proof of your authorization.

Please select if you do not wish your information to be included on the publicly available SE Credit Provider List. Provided information includes name, work phone, email, professional title, city, state/province, country, languages spoken, and levels approved for.*

We would like to make sure we have the right information for your listing. Please fill out the fields below and an SEI Staff Member will work to update the information on the back end. 

Name
Address
By submitting this application, I certify that all the information included in this application is true and complete.*
I acknowledge that the Somatic Experiencing International reserves the right to approve or deny any application, revoke approval at any time, and approve or deny the participation of any person, in its sole discretion, with or without cause, and in accordance with its policies and the law.*
I have read the Agreements and Expectations and understand the conduct agreements between Somatic Experiencing® International, faculty, assistants, students, coordinators, SEP’s, committee members, administrative staff, and all participants involved in the organization, to promote a welcoming and supportive environment. I acknowledge that I will adhere to the Agreements and Expectations in all activities related to Somatic Experiencing International.*

Follow the link to read Agreements and Expectations between Somatic Experiencing® International, faculty, assistants, students, coordinators, SEP’s, committee members, administrative staff, and all participants involved in the organization, to promote a welcoming and supportive environment.

Use your mouse or finger to draw your signature above
Date/Time*
:  
Progress
Cancel
Confirm