Application Form – Residential Training Program

To pay by check, please download the application form and mail with the check.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Occupation

Professional License

License #

Residential Training Program

Deposit Only - $500.00

Full Tuition - $2,400.00

Residential Training Program - Other Amount

Total

Phone

This field is for validation purposes and should be left unchanged.

Faculty

Armin Baier
L.C.S.W., J.D.

Gary Yontef
Ph.D., A.B.P.P.

1800 Fairburn Ave
Suite 103
Los Angeles, CA 90025
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