Application Form AIC - CiiAT | Canadian International Institute of Art Therapy

Contact Information
Name*
First Last
Email*
Phone*
Date of Birth (dd/mm/yyyy)*
Gender (required for contract)*
As requested by the Private Training Institutions Branch of British Columbia, we are obligated to ask for gender.
- Female
- Male
- Prefer Not to Say
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How did you hear about us?
- Word-of-mouth (friend/family/colleague)
- Social Media
- Organic search (Google)
- Newsletter
Emergency Contact
In the event of an emergency or if we are unable to reach you, we will contact this person for urgent matters.
Emergency Contact Name*
Relationship*
Phone*
Email*

CiiAT | Canadian International Institute of Art Therapy