Membership Application

Mental Health Professionals

Mental Health Professionals - Commitment and Certification of Credentials

Name(Required)

First Middle Last

Email(Required)

Enter Email Confirm Email

I hereby certify that I will:(Required)

Am a professional licensed as a Ph.D., Ed.D, Psy. D., LCSW, MFT, MD, or LPC to practice and in good standing in DC, VA and/or MD and that I currently maintain professional liability insurance (if required by licensing body).

Have at least three years experience in Mental Health practice with substantial amount of practice devoted to family or divorce issues if accepting family or divorce Collaborative cases [either a [comment field, short text] or just the check-box. Morna will confirm].

Have a currently active practice substantially devoted to family or divorce issues or substantially devoted to following area of expertise in which I will be accepting Collaborative cases [comment field, short text].

Currently practicing in the following area of practice: (if not applicable please reply N/A)

I further certify that I:

Have background, education, and experience in the following areas necessary to hold myself out as a Coach or Mental Health Expert OR will not hold myself out as a Coach or Mental Health Expert in these areas: family and couples therapy and family systems theory, child development (child therapy encouraged), stages of family development including the unique challenges of diversified families and children with special needs, divorce related issues, including its impact on family development and the transition post-divorce, conflict resolution for couples, co-parents and parent-child relationships, and high conflict divorce and its impact on children.

Have background, education and experience in the following areas necessary to hold myself out as Child Specialist OR will not hold myself out as Child Specialist in these areas: child development (child therapy encouraged), stages of family development including the unique challenges of diversified families and children with special needs, divorce related issues, including its impact on family development and the transition post-divorce, and high conflict divorce and its impact on children, child and adolescent therapy.

If accepting Collaborative divorce or family cases, completed three hours of training in family law in the jurisdiction in which I practice.

Experience in the following area of practice: (if not applicable please reply N/A) (Required)

Attach Evidence of:

1. Current license, and
2. Current malpractice insurance coverage
or explanation as to why it is not attached.

Max. file size: 128 MB.

Mental Health Professional Commitment and Certification of Foregoing

I swear and/or affirm that the contents of the foregoing are true and correct to the best of my knowledge.

Attorneys Certification

Attorney Applicants - Commitment and Certification of Credentials

Name(Required)

First Middle Last

Email(Required)

Enter Email Confirm Email

I hereby certify that I will:(Required)

Accept Collaborative cases only in the jurisdictions in which I am licensed.

Have at least three years of domestic relations legal experience if I will be accepting family or divorce Collaborative cases, or other comparable experience approved by the Executive Committee or, alternatively, have at least three years experience in the following area of practice in which I will be accepting Collaborative cases [comment field, short text].

At least 3 years of experience in the following area of practice: (if not applicable please reply N/A) (Required)

I further certify that I:

Currently have an active practice in domestic relations if I will be accepting family or divorce Collaborative cases or in the following area of practice in which I will be accepting Collaborative cases [comment field, short text].

Experience in the following area of practice: (if not applicable please reply N/A) (Required)

Attach Evidence of:

1. Current mandatory bar membership, and
2. Current malpractice insurance coverage
(or explanation as to why not attached).

Max. file size: 128 MB.

Attorney Commitment and Certification of Foregoing

I swear and/or affirm that the contents of the foregoing are true and correct to the best of my knowledge.

Financial Professionals

Financial Professionals - Commitment and Certification of Credentials

Name(Required)

First Middle Last

Email(Required)

Enter Email Confirm Email

I hereby certify that I will:(Required)

Am a professional licensed as a CPA (Certified Public Accountant) or CFP (Certified Financial Planner) to practice and in good standing in DC, VA and/or MD and that I currently maintain professional liability insurance (if required by licensing body).

Have at least three years of experience in financial practice with substantial amount of the practice devoted to family or divorce issues if accepting family or divorce Collaborative cases.

Have a currently active practice substantially devoted to family or divorce issues or substantially devoted to other area of practice in which I will be accepting Collaborative cases [comment field, short text].

Currently practicing in the following area of practice: (if not applicable please reply N/A)

I further certify that I:

Have background, education, and experience in financial aspects of divorce, cash management and spending plans, retirement and pension plans, income tax, investments, real estate, insurance, property division, individual and family financial planning concepts, domestic relations experience, or other comparable experience approved by the Board or Executive Committee OR will not hold myself out as practicing in these areas.

If accepting family or divorce Collaborative cases, completed required training in the financial fundamentals of divorce or will complete such training within one year.

Attach Evidence of:

1. Current license, and
2. Current malpractice insurance coverage
or explanation as to why it is not attached.

Max. file size: 128 MB.

Financial Professional Commitment and Certification of Foregoing

I swear and/or affirm that the contents of the foregoing are true and correct to the best of my knowledge.

COLLABORATIVE PROFESSIONALS OF NORTHERN VIRGINIA, INC. (CPNV)

Application

Background, Education and Experience (Include a description of field and nature of experience sufficient to meet requirements of membership 30 hours of Mediation Training is required within one year of Introductory Training. )

Mental Health Professionals

Attorneys Certification

Financial Professionals

COLLABORATIVE PROFESSIONALS OF NORTHERN VIRGINIA, INC. (CPNV)

Application

Background, Education and Experience (Include a description of field and nature of experience sufficient to meet requirements of membership 30 hours of Mediation Training is required within one year of Introductory Training. )

Mental Health Professionals

Attorneys Certification

Financial Professionals

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