Please fill out the form below. Fields marked with an asterisk* are required.
Please note: This is the Connecticut version of EASy. If you are applying in another state, please be sure to select that state from the drop-down below.
Before completing the remainder of the registration form, please review the following requirements for IFS Endorsement and consider whether each of the bullets applies to you:
Before completing the remainder of the registration form, please review the following requirements for ECFS Endorsement and consider whether each of the bullets applies to you:
Before completing the remainder of the registration form, please review the following requirements for IMHS Endorsement and consider whether each of the bullets applies to you:
Before completing the remainder of the registration form, please review the following requirements for ECMHS Endorsement and consider whether each of the bullets applies to you:
Before completing the remainder of the registration form, please review the following requirements for IMHM-C Endorsement and consider whether each of the bullets applies to you:
Before completing the remainder of the registration form, please review the following requirements for ECMHM-C Endorsement and consider whether each of the bullets applies to you:
Before completing the remainder of the registration form, please review the following requirements for IMHM-P Endorsement and consider whether each of the bullets applies to you:
Before completing the remainder of the registration form, please review the following requirements for ECMHM-P Endorsement and consider whether each of the bullets applies to you:
Before completing the remainder of the registration form, please review the following requirements for IMHM-R/F Endorsement and consider whether each of the bullets applies to you:
Before completing the remainder of the registration form, please review the following requirements for ECMHM-R/F Endorsement and consider whether each of the bullets applies to you:
Please use a personal email address (yahoo, gmail, etc.) as many agency email servers block emails from EASy.
Please provide a brief description of your work experience with pregnant women, infants, young children and their families:
You may attach a résumé or curriculum vitae. This is recommended if you have more than 3 relevant paid work experiences.
File should be in .PDF, .DOC, .DOCX or .RTF format
mm/dd/yyyy
You must join or renew membership to CTAIMH (or another infant mental health association) when submitting this preliminary application.
Extra members will add $30.00 per person
Please review and verify all data before submitting!