Submit Professional Development Portfolio

As part of the EAGALA Certification process, a professional development portfolio must be submitted. This is to be done before attending your Part 2 training and will be kept on file at the EAGALA Office.

You can submit your portfolio by filling out the following online form, or you may send it via email to stefany@eagala.org or mail it to the EAGALA office.

Date: *

First and Last Name: *

Complete Mailing Address: *

Email: *

Phone: *

Website:

Signature Statement - "I commit to adhering to EAGALA's standards and ethical code.": *

Please type your first and last name as your signature agreeing to the above statement.

Why do you wish to work as an EAGALA Model facilitator?: *

What strengths do you bring to this?: *

What areas of your own professional development do you wish to focus on?: *

Team Role: *

Equine Specialist (ES)

Mental Health Professional (MH)

Both MH and ES

Other Professional or Student

Please select which role in the team you meet EAGALA's standards to serve in. You will need to submit information on how you meet those standards in the following section.

Mental Health Professionals - click here to fill out this section

If you plan on serving as the MH side of the EAGALA team, complete the following questions 1 - 4.

1. University-level education received in mental health field/scope of practice:

Write what your university-level education is in that allows you to fulfill the MH side of the team. Include degrees obtained and what those degrees are in, and how it allows mental health as your scope of practice.

2. I will stay within my scope of practice and follow laws and regulations in my state/country regarding mental health practice.:

Yes

3. I am practicing under a governing body/board/association which can hold me accountable for my practice. Please describe.:

i.e. list your licensure, registration, and/or certification information and number relating to mental health practice which falls under a governing body which has authority to remove or revoke this accreditation.

4. Please copy and paste your resume (listing work experience) information here, or email your resume to stefany@eagala.org.:

If you are going to email your resume to Stefany@eagala.org, please write in the field above that you are doing this.

Equine Specialists - click here to fill out this section

Equine Specialists - complete the following questions 1 - 4.

1. I have at least 6,000 hours of hands-on work experience with horses over my lifetime. Please describe how you obtained this.:

2. I have completed at least 100 hours of continuing education in the horse profession. Please list what you have done here.:

Continuing education includes horse-focused workshops, school, lessons, certifications and videos. Some of this education needs to include topics covering: ground work experience, horse psychology knowledge, and ability to read horse body language/nonverbal communication.

3. 40 hours of the continuing education listed above needs to have been completed in the last 2 years. List this.:

4. Please write your school and work experience here, or email your resume to stefany@eagala.org.:

If you are going to email your resume to Stefany@eagala.org, please write in the field above that you are doing this.

Other Professionals/Students - click here if you do not qualify as a MH or ES

If you are a student or other professional (and do not qualify as a MH or ES), please fill out this section questions 1-2.

1. I understand that the EAGALA standard requires a team of MH and ES, and that I will serve as a 3rd member of the EAGALA team:

Yes

2. Please state your area of specialization or what your role will be in the EAGALA session:

Any other comments:

Thank you for filling out this form. You may click Submit to send your information to the EAGALA office.

EAGALA Primary site

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