STLDBT Post Graduate DBT Therapist Application Form

St. Louis DBT Post Graduate Program Application

Please complete the form below, submit your cover letter, resume, and letters of recommendation from clinical course professors and clinical practicum supervisors. You will also list two professional references. References will not be contacted until after interview process.
Name:*

First NameLast Name
Birth Date

MonthDayYear
Phone Number:*

Area CodePhone Number
E-mail Address:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How were you referred to us?*

Current EmployeeProfessor, Teacher, or schoolSupervisorNewspaper AdFacebookLinked-InInstagramOther
Upload Cover Letter

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Upload Resume

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Upload Letters of Recommendation

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Upload Transcript

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Job Skills & Training
Check all that apply (not all are required)

I have graduated (or are within 2 months of graduating) from an accredited school of social work. *RequiredI have completed coursework in evidence-based practices. * RequiredI have completed a clinical practicum. *RequiredI have passed my LMSW test and am a pre-licenced social workerI have completed a basic DBT training or equivalent courseI have read Marsha Linehan’s DBT manualsI have read Kelly Koerner’s “Doing DBT” or another DBT manual
Name of Graduate School and month/year of graduation
Other Training or Certifications:
References

Please list two (2) references that are familiar with your work life. References will NOT be contacted until after the interview process. By listing a reference here, you are agreeing to allow STLDBT to send this reference a survey about your work performance and suitablity for this position.
Reference 1
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years Known:*
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference 2
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years Known:*
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Should be Empty:

St. Louis DBT Post Graduate Program Application