Forms and Resources
If you have any questions for concerns about the use or submission of these forms, contact Cindy Flores the Practicum Coordinator at cindy@theraplay.org
Certification Procedures (PDF) (DOC)
Practicum Registration Materials (PDF) (DOC)
Practicum Attestation (PDF) (DOC)
Sample Permission Letter (PDF)
Consent to Videotape Form (PDF) (DOC)
Session Tracking Log (PDF) (DOC)
MIM Forms
MIM Analysis Form (PDF) (DOC)
MIM Analysis Example Form (PDF)
Theraplay Supervision Session Forms
Theraplay Session Supervision Form (PDF) (DOC)
Sample Supervision Session Form (PDF)
Parent Session Supervision Form (PDF) (DOC)
Self Description by Dimension Forms
(Please include the Intermediate/Final Checklist when submitting Self-Description by Dimension Form)
Foundational Evaluation (8th Session) (PDF) (DOC)
Intermediate Evaluation Form (PDF) (DOC)
Sample Intermediate Evaluation Form (PDF)
Final Evaluation (PDF) (DOC)