Reference Form for AAP Membership Application
AAP Membership Chair
Nelia H. Rivers, L.C.S.W.
736 Darlington Circle NE
Atlanta, Georgia 30305
The person listed below is applying for membership in the American Academy of Psychotherapists and has listed you as a reference. To help us evaluate this applicant for membership, we would appreciate your reply to the following questions. The applicant has agreed this information may be released and your answers will be considered confidential. If you have been the applicants' therapist you need only to validate the number of therapy hours that the applicant spent with you.
Name of Applicant
Please answer the questions that best apply to you.
How many hours has the applicant spent in therapy with you?
How many hours has the applicant spent in supervision with you?
How long have you known the applicant and in what capacity?
As a supervisor, therapist or colleague what are your impressions of the applicant as a therapist?
In your opinion, is the applicant qualified for the independent practice of psychotherapy in his/her discipline?
If you are a current or former AAP member, do you recommend this applicant for membership?
Typing my full name in the box below serves as my signature for this reference form.
Relationship to applicant
Thank you for your time in filling out this reference form. In order to authenticate your reference, please send an email to:
Do Not Fill This Out