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1Account Information
2Address
3Emergency Contact
4Eligibility
5License
6Clinical Supervisor
7Business Details
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Name*
Have you COMPLETED at least one of the following?
Do you currently hold any type of mental health related state licensure (provisional or independent)?
Does your mental health related license allow you to practice clinical work independently (without supervision) in your state of licensure?
Does your mental health related license allow you to practice clinical work UNDER SUPERVISION in your state of licensure?

Congratulations, you qualify for the non-accredited learner track and are eligible to take T3 and/or Introduction to CMI.

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I would like for my information to be displayed on the ARISE website as a licensed clinical provider
Max. file size: 100 MB.

Please upload a copy of your provisional, intern, or non-independent license and provide your license information. If you are licensed in multiple states, please use your state of primary practice.

Please be advised that verification of active supervision is required to qualify for this course.

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ARISE Alliance Institute is a 501(c)(3) tax-exempt organization. A copy of the official registration (CH49871) and financial information may be obtained from the Florida Department of Agriculture and Consumer Services by calling toll-free within the state 1-800-435-7352.

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