Full Name

Professional Role / Title

Highest Relevant Credential

License / Certification State or Country

Email Address

Phone Number

Organization / Workplace

Primary Setting Primary Setting SchoolCommunity ProgramResidentialClinic or Private PracticeVirtual PracticeOther

Populations You Primarily Serve Populations You Primarily Serve Youth (12–15) Emerging Adults (16–25) Families Staff

Years of Experience in Youth or Young Adult Work Years of Experience in Youth or Young Adult Work 0–23–56–1010+

Are you seeking certification for yourself or to represent an organization? Are you seeking certification for yourself or to represent an organization? Myself only On behalf of an organization

Preferred Start Timeline for CSP™ Certification Preferred Start Timeline for CSP™ Certification Next available cohortWithin 6 monthsNot sure

What motivates you to pursue CSP™ certification?

How did you hear about THEE S.C.H.O.L.A.R. Institute or CSP™?

Acknowledgment Checkbox Acknowledgment Checkbox I understand that CSP™ certification requires a financial investment and agree to receive tuition and cohort details by email.”