RMPTI Application for Supervision

Please fill in the following form and send. A CC of the form will also be sent to your email. If you do not receive it please check your spam box. If there is the possibility you typed in your email incorrectly please contact RMPTI to confirm the application and correct the email address.

You are also required to read and forward the OnLine Supervision Agreement which is required for registration. To access this form click here (pdf document) You will need Adobe Reader – this is a fillable form – Once downloaded please save to your computer using your last name, fill in and save, then email as an attachment to RMPTI with the subject line “supervision agreement”.

Last Name

First Name

Your Email (required)

Mailing Address



Postal Code/zip


Phone number with area code

List University Degree(s)/Highest Academic Achievement & Dates Received

Relevant Training & Professional Experience:

Videoconference Group SupervisionFace-to-Face Individual SupervisionDistance Individual Supervision

Note: Once approved, you will be sent a link for making the deposit payment through Paypal. A deposit is required to secure your position in the program.

Please "verify" by entering the numbers/letters into the box, then click the send button


Cancellation Policy

The deposit is non-refundable. No refunds of course fees will be provided for any reason whatsoever unless there is illness or a death in the family. RMPTI will require a doctor’s certificate or funeral information. Participants meeting this criteria will be provided with credit to attend an equivalent course (time, content, fee). This credit will be available to the participant for a period of one year from date of issuance. Rocky Mountain Play Therapy Institute reserves the right to cancel any course in the event of unforeseen circumstances. In such an event, an attempt will be made to notify registrants at least two weeks prior to the course start date and the full registration will be returned. In all instances, RMPTI’s liability is limited to refund of registration fees only.