Professional Network

Apply for Consortium Membership

Join a diverse group of like-minded behavioral health professionals committed to excellence in clinical practice and research.

Consortium Application Form

Please complete all sections of this application form. Your information will be reviewed by our consortium committee.

Demographic Information

Full Names *

Phone Number *

Email Address *

Education/Career

Degree(s) *

Name(s) of University where you earned your degree(s) *

Professional License Number

Professional Board *

Member Number *

Clinical Area of Expertise *

Research Area of Interest *

Current Employment *

Essay

Briefly explain how your a) Personal values and b) Professional career plans meet the objectives of Recro Group Limited-Consortium.

Minimum 150 words.

Essay *

Professional Referees

Kindly provide three professional referees with your application.

Referee 1

Full Name *

Phone *

Email *

Organization *

Referee 2

Full Name *

Phone *

Email *

Organization *

Referee 3

Full Name *

Phone *

Email *

Organization *

By submitting this application, I confirm that all information provided is accurate and complete. I understand that membership requires adherence to ethical guidelines and regular participation in monthly meetings.

Questions about the application?
Contact us at 0717-78-78-07 / 0717-78-78-08 or info@recrogroup.org