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

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

At the Relational Life Institute, we aim to better understand the diverse backgrounds and experiences of individuals interested in bringing Relational Life Therapy (RLT) to their communities. This information helps us to ensure that RLT is accessible and impactful for everyone. Your responses are voluntary, confidential, and greatly appreciated.

Gender Identity

Cultural Background/Ethnicity

Are you a part of any minority or underrepresented group?

Other aspects of your identity you wish to share that may shape your approach to relational work?

Thank you for contributing to our understanding of the RLT community!