SOS Approach to Feeding Certification Application

Contact Information
Name:*
Title:*
Organization:*
Street Address:*
Address - line 2
State/Province/Region*
E-mail:*
Verify Email:*
Website address:
Phone number:*
Mobile Phone:

Professional Experience & Focus
Profession:*
If you selected other, please specify:
Primary Work Setting:*
What is the primary population of your feeding therapy services?*
If you selected Other, please specify:
How many years of pediatric work experience do you have?*
How many years of feeding therapy experience do you have?*
What percentage of your caseload is Feeding Clients?
How many years have you been implementing the SOS philosophies into your practice?
At what level do you implement the SOS philosophy?

SOS Basic Conference (pre requisite to certification program)
Basic SOS Approach to Feeding Training Dates:*
City of Conference:*
Advanced Courses: (if applicable)
Upload your Basic conference certificate. (Please contact the conference host if you need a replacement copy). *

Certification Program
How did you hear about the Certification Program?*
If you selected the option - Other, please specify:
What are your goals for the Certification Program (Please list up to three main objectives):*

Document Uploads
Upload CV or Resume (please include a detailed list of continuing education programs that you have attended, noting dates and instructor's names):*
Upload a personal photo:

By checking the box, I have read and understand the cancellation policy.*
By checking the box, I have read and understand the course requirements and expectations of participants.*