You can always press Enter⏎ to continue
Welcome 

Welcome 

Brainspotting Phase 1
20Questions
  • 1
    Press
    Enter
  • 2
    Press
    Enter
  • 3
    Please Select
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
    Press
    Enter
  • 4
    Press
    Enter
  • 5
    Press
    Enter
  • 6
    Press
    Enter
  • 7
    School/Program/Anticipated Graduation Date
    Press
    Enter
  • 8
    Press
    Enter
  • 9
    Press
    Enter
  • 10
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 11
    Press
    Enter
  • 12

    We are excited to be teaching you this Phase 1 Brainspotting Class and are dedicated to creating a safe place for all to learn. Please fill out this section of the form to tell us a little abt you before class begins. You can skip questions you do not feel comfortable with.

    Press
    Enter
  • 13
    Press
    Enter
  • 14
    Press
    Enter
  • 15
    Is there any part of the training you know you will not be able to attend? Please explain below. This training requires attendance at all practicums, but it's helpful for us to know if you might have to step away for an hour or leave early one day so that we can manage the practicums and help you make up anything that you might miss.
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 16
    Press
    Enter
  • 17
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 18
    It is important to us that everyone feels comfortable in our training. That said, is it important to you that you are paired with someone of a certain population? For example, another LGBTQ person, a BIPOC, or even someone of the same gender? Or is there something else we need to know to successfully partner you up in the practicums? Please let us know. We will make every effort to honor your request, although we are not always able to do so.
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 19
    Equity, Diversity, and Inclusivity Statement: We are committed to creating an equitable, diverse, and inclusive community where everyone is welcome. In doing so, we promise to make every effort to recognize, address and eradicate any and all forms of racism, oppression, intolerance, negative judgments, and mistreatment directed toward marginalized communities and individuals. We also understand that bias may not always be intended. We ask that everyone commit to doing their best with an open and humble willingness to grow and learn. We also ask that you join us in committing to act in a respectful manner and to maintain confidentiality related to the work of each participant. Deb and Sue and our entire organization strive to exemplify these values for all staff, clients, and training participants. Thank you for helping us to uphold these commitments during your time with us.
    Press
    Enter
  • 20

    PLEASE NOTE THAT REGISTRATION FOR THIS CLASS IS NOT COMPLETE UNTIL YOU HIT SUBMIT BELOW AND FORWARD PAYMENT FOR THE CLASS.

    We offer NJ NASW CEs for free. Some states may accept these CEs. Please check with your licensing board. 

    The cost of the class changes based on when you register. Please go to www.coherentself.com and look for the Brainspotting Class you are signing up for to see the current cost for the class.

    To pay, please use Zelle and send the money to SPinco96@yahoo.com or to phone number 201-747-6789, or Venmo @Susan-Pinco. If you prefer to pay by check, please email spinco96@yahoo.com to notify her of your intention to send a check and she will notify you of the address to mail the check to. You may also pay via PayPal @DrSusanPinco. If your paypal account is associated with a credit card you will be responsible for the 4% processing fee. You may also ask for a square invoice that carries a processing fee of 3% which will be included in your total.

    Press
    Enter
  • Should be Empty:
Question Label
1 of 20See AllGo Back
close