Application Form APD - 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
Citizenship*
How did you hear about us?
- Word-of-mouth (friend/family/colleague)
- Social Media
- Organic search (Google)
- Newsletter

Application
We offer quarterly intake for the diploma program. When would you most like to begin the program?*
- January 2022
- April 2022
- July 2022
- September 2022
Student Loans:*
As we cannot provide student loans, would you like more information about payment plan options?
- Yes
- No
Please upload the following with your application:*
1. A current resume and/or transcripts and certificates
Drop files here or
Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 64 MB.
Please upload the following with your application:
2. 3 psychology courses such as Introduction to Psychology, Child and Adolescent Development, Human Development, Abnormal Psychology, Theories of Personality, Developmental Psychology, History of Psychology, and Counseling Skills *If you have not previously completed the 3 psychology courses and are planning on completing them as a corequisite to the diploma program, disregard this box.
Drop files here or
Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 64 MB.
Please upload the following with your application:*
3. A portfolio of 10 pieces of artwork (including a variety of media, which may include sculpture, painting, or photography)
Drop files here or
Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 64 MB.

Education
What is your highest qualification?*
- Partial College/University
- College/University
- Post-Graduate
If other, please explain:
Degree (if applicable)

References
Please list two professional references.
Name of First Reference*
First Last
Relationship*
- Employer
- Colleague
- Professor/Instructor
If other, please explain:
Company Name*
Company Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name of Second Reference*
First Last
Relationship*
- Employer
- Colleague
- Professor/Instructor
If other, please explain:
Company Name*
Company Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Disclaimers & Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to an offer of acceptance into the program and school, I understand that false or misleading information in my application or interview may result in termination of my application process.*
- Yes, my answers are true, and I understand.
I understand that if I am applying to the Art Psychotherapy Diploma Program, I will need to include an application fee of $150 with my application. Upon receipt of this application form, CiiAT will invoice me $150.*
- Okay, I understand.
Signature*
Date*
MM slash DD slash YYYY

CiiAT | Canadian International Institute of Art Therapy