• Affiliate Request

BCCBT Affiliate Network Request

Thank you for your interest in becoming a member in our affiliate network. Please fill out the form below. Once we reviewed it, we will send you an email with our decision.

The membership is $150/year.

Name

with credentials

First Name

Last Name

Address (primary office):

Phone

(###)

###

####

Website:

Are you currently licensed to practice psychotherapy in the state of Colorado?

If no, are you working toward licensure?

Is it accurate for us to say that you provide evidence-based psychotherapy?

Specifically, what models of therapy do you offer (e.g., CBT, ACT, BA)?

Other Comments:

By signing (typing your name) below, you are indicating that you would like to be a member of the BCCBT affiliate network. You understand that this is NOT a referral service, and that BCCBT makes no promises regarding professional training opportunities that will be offered in the current year.