Application

Personal Details
Professional Background & Experience
Previous RLT Training

RLT Certification Application Form

You’re applying for the RLT Certification

The application only takes five minutes to complete and helps us determine the most suitable Certification pathway for you. Once you submit your application, our team will review it and reach out to finalize your enrollment or ask any follow-up questions.

First Name

Last Name

Pronouns

Phone/Mobile

Email

Professional Listing/Website (if applicable)

Country

Which title best describes your current profession?

Psychologist/Psychiatrist/Psychotherapist

Counselor

Social Worker/Marriage and Family Therapist

Life/Relationship/Executive Coach

Student in Therapy or Coaching Related field

Other > Please Specify

How many years have you been working in this field?

Do you hold a license to practice?

Yes

No

Associate

Not Applicable in my country

What is your expected date of full licensure (estimate is fine)

By which regulatory body are you licensed by/registered with?

What is your highest level of education?

Do you have any other relevant certifications/qualifications to support your application?

Do you currently maintain malpractice/indemnity insurance?

Yes

No

How many clients are you currently working with?

I’m not currently working with clients

0-5/week

6-15/week

15+/week

Are you currently working with couples?

Yes, couples work is my primary focus.

Yes, but it is not my primary focus.

No, I haven't worked with couples before.

No, but I have worked with couples in the past.

Please tell us the institution you are enrolled in and the degree or certificate you are studying for:

What is your expected date of graduation?

How many years have you been working in this field?

Do you have any other relevant certifications/qualifications/experience to support your application?

Do you currently maintain malpractice/indemnity insurance?

Yes

No

How many clients are you currently working with?

I’m not currently working with clients

0-5/week

6-15/week

15+/week

Are you currently working with couples?

Yes, couples work is my primary focus.

Yes, but it is not my primary focus.

No, I haven't worked with couples before.

No, but I have worked with couples in the past.

How many years have you been working in this field?

If applicable, by which regulatory body/bodies are you registered with?

What is your highest level of education?

Do you have any other relevant certifications/qualifications/experience to support your application?

Do you currently maintain malpractice/indemnity insurance?

Yes

No

How many clients are you currently working with?

I’m not currently working with clients

0-5/week

6-15/week

15+/week

Are you currently working with couples?

Yes, couples work is my primary focus.

Yes, but it is not my primary focus.

No, I haven't worked with couples before.

No, but I have worked with couples in the past.

Do you have a website/professional profile/listing? If so, please share link/s here:

Please describe your current profession, experience with clients and education to date.

How long have you been working in this field?

Do you currently maintain malpractice/indemnity insurance?

Yes

No

How many clients are you currently working with?

I’m not currently working with clients

0-5/week

6-15/week

15+/week

Are you currently working with couples?

Yes, couples work is my primary focus.

Yes, but it is not my primary focus.

No, I haven't worked with couples before.

No, but I have worked with couples in the past.

Have you done any previous training with the Relational Life Institute?

Yes

No

Please select which trainings you have completed:

The Relational Life LEVEL 1 Training

The Relational Life LEVEL 2 Training

The Relational Life LEVEL 3 Training

The Relational Life Boot Camp/Essential Skills Workshop

Observing Terry’s Couples Experiential

Professional Teleclass or Webinar Series/Special Topic Course

Real Life Membership

Other

Please specify the other trainings you have completed:

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