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Please specify below: License # Disability StatusDo you have a disability as defined by the Accessible Canada Act? No Yes Your Disability(Required)Please let us know of any accommodations we can make to best support your learning process. We will do our best to reasonably accommodate any requests, however, we may not be able to accommodate all requests. We do not say this to discourage you from submitting your accommodation request but rather to ensure you can also begin to consider alternative options should we be unable to meet your accommodation. If Elsewhere in Canada or the US please specify Contact Number(Required)Alternate Contact NumberWhat is your current profession? Include any area of specialisation:(Required)Where and when did you complete or expect to complete Intermediate III?(Required)Please select a locationVancouverKelownaEdmontonSaskatoonElsewhere in Canada or the USCompletion Date(Required) Please upload a copy of your most recent SEI certificate of completion in JPG or PDF format.(Required)Max. file size: 50 MB.I’ve had a major traumatically-stressing event within the past year.(Required) No Yes I understand that the SE training may trigger past traumas(Required) No Yes Are there any grievances, complaints, or actions pending or upheld against you for misconduct as a professional by any licensing, regulating, or associate body?(Required) No Yes If Yes, please provide details and relevant information you are legally permitted to disclose here:Anything else you would like us to know?:All information submitted will be held in strict confidence. Once we have reviewed your application you will be notified by email of your application status. 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