The Human-Equine Relational Development Institute

Equine Facilitated Psychotherapy (EFP) Application Form

Please fill in and submit this form to enroll in our Equine-Facilitated Psychotherapy US Certification program. The HERD Institute undertakes to keep all your information confidential and secure, and will not share your information with third parties.
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Please list Year, Institution, and Degree/Certificate Awarded
Please list Year, Institution, and Degree/Certificate Awarded
Please list Year, Institution, and Degree/Certificate Awarded
Please list: Year, Length of Program, Name of Program
Please list: Year, Length of Program, Name of Program
Please list: Year, Length of Program, Name of Program
DECLARATION: By typing my name in the Applicant Electronic Signature box above, I declare that all the information I have provided is true and complete to the best of my knowledge and that The HERD Institute has my permission to obtain all necessary information from the references I have listed concerning my past experience and I release all parties from any possible damages resulting from disclosing such information with or without prior written notice from me. I understand that this application does not constitute a contract of any kind. Should the HERD Institute enroll me, I may terminate such enrollment at any time. I have read and agree to the above statement and understand that by entering my name, I agree to the terms.
Please Provide the Following References:
  1. Reference from a Licensed Mental Health Practitioner (i.e. therapist, colleague, supervisor, professor, etc.)
  2. Reference from an Equine Professional (i.e. riding instructor, trainer, farrier, vet, etc.)

    Please have each of them complete our online reference request form: https://forms.gle/dhLuKCvDwa1ZoAtY7