Therapist Registration Form

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home or Cell Phone*
Work Phone
Email*
Website
Registration Information
Please select your registration type:*
- Registered Educational Therapist
- Parent Educational Therapist
- Associate
Training Information
Please select all of the training courses you have completed:*
- Level I Educational Therapy
- Level II Educational Therapy
- Level III Educational Therapy
- Teletraining Workshop (NILD U.S.)
- Search & Teach
- Rx 4 Math
- Rx 4 Math II
- Rx for Reading
- Rx for Reading - Fundamentals
- Rx for Writing
- Rx for Writing - Fundamentals
- Executive Function Workshop
- Group Educational Therapy
- WJIV Workshop
- FIE Standard I
- FIE Standard II
- FIE Basic I
- FIE Basic II
Click here to see the policies and procedures regarding steps to certification and therapist benefits for NILD Educational Therapists.
Have you taken the NILD Teletherapy training with NILD U.S. and renewed your Teletherapy license with them?*
- Yes
- No
For PCET re-certification, you must complete the two items here as well as two options from the second list to retain your PCET status. If you have not fulfilled these requirements, you will receive a Certified Educational Therapist certificate but may re-apply for PCET status the following year.*
- Attendance at the Annual Conference or Fall Seminar within the last year.
- 160 student contact therapy hours within the past year.
Completion of TWO of the following options:*
- NILD Canada course or workshop (FIE, Rx, etc)
- Two webinars (by NILD or within related field)
- NILD therapist support (Mentorship, PST Leader)
- A course or workshop in an education related field
- Present a workshop at an NILD Conference or industry related conference
What NILD course or workshop did you take?*
What webinars by NILD or within related field did you take?*
What course or workshop in an education related field did you take?*
What workshop did you present? And where?*
Therapy Work History
Please provide history for the previous school year.
Where did you practice NILD Educational Therapy this past year?*
Choose the option that most accurately reflects where you provide therapy.
- Private Practice (self-employed at home, at a centre or at a school)
- School (employed by the school, providing ET as part of resource)
- Home (provide therapy for my own child)
- New therapist - yet to be determined
As a private practice therapist, have you secured liability insurance? You are welcome to use the provider linked below if you wish.*
- Yes
- No
Find all the insurance information here: https://nildcanada.org/therapists-and-associates/business-marketing/
Name of Practice/Therapy Centre/School #1*

If you don't have a name for your practice, please enter your first and last name.
Practice/Therapy Centre/School Address #1
*enter only if different from your personal address entered above

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Practice/Therapy Centre/School Phone Number #1
Do you practice in another location?
- Yes
- No
Name of Practice/Therapy Centre/School #2*
Practice/Therapy Centre/School Address #2
*enter only if different from your personal address entered above

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Practice/Therapy Centre/School Phone Number #2
Number of Educational Therapy students in 2022/2023*
Number of SEARCH students scanned in 2022/2023*
Number of TEACH students taught in 2022/2023*
Please submit each of your students' annual testing scores through our online form.*
- Done!
Click here to go to the form
Would you like to be listed this year on the Find a Therapist page on the NILD Canada website with your contact information?*
- Yes
- No, I do not want to be listed
Click here to view the web page where your information will be displayed.
Are you currently listed on the Find a Therapist page?*
- Yes
- No
Click here to view the web page where your information will be displayed.
Please review your contact information on the Find a Therapist page on our website. If you would like any changes made, please indicate them here.
Please indicate the contact information you would like listed on our website (Canadian therapists only). You must choose one street address to be listed.*
- First Name
- Last Name
- Address
- Email Address
- Home or Cell Phone Number
- Work Phone Number
- Website
- Work/Therapy Centre/School Name #1
- Work/Therapy Centre/School Address #1
- Work/Therapy Centre/School Phone #1
- Work/Therapy Centre/School Name #2
- Work/Therapy Centre/School Address #2
- Work/Therapy Centre/School Phone #2
- Please don't use any of these addresses, please use the local town hall address
Please indicate the services you would like listed on our website.*
Note: In order to practice NILD interventions digitally and be listed as a Teletherapist, you must take a workshop with NILD US and purchase a Zoom license from them. For more information, click here
- NILD Educational Therapist
- Search & Teach Provider
- NILD Educational Teletherapist
- FIE Practitioner
Are you a member of the NILD Canada Educational Therapists Facebook group?*
- Yes
- No
Click here to go to the Facebook group and request to join if you're not already in!
Are you a friend of NILD Canada, an inactive Educational Therapist, a Search & Teach Provider, or an Rx Provider? Please select all that apply.*
- Friend of NILD Canada
- Inactive Educational Therapist
- Search & Teach Provider
- Rx Provider
I give permission for any photos taken of me at NILD conferences or courses to be used for promotional purposes.*
- Yes
- No
I understand that my annual registration expires September 30, 2024. At that time I will need to renew my membership and pay the annual registration fee.*
- Yes
- No
Comments or questions? Please leave them here and we will respond!
FOLLOW and LIKE US on Facebook and please share our Facebook page with your family and friends!

Therapist Registration Form

Registration Information

Training Information

Therapy Work History

NILD Canada Blog

You have Successfully Subscribed!