Dear Colleague:

The Association for the Treatment and Prevention of Sexual Abuse (ATSA) is a non-profit, professional organization that was developed to promote professional competence, high ethical standards, and responsible research and training for persons involved in the assessment and treatment of sexual abusers.

The person who requested that you visit this page has applied for membership in ATSA.  You have been listed as a reference to speak to the personal and professional qualifications of the applicant.  The membership committee would appreciate you completing the information below.  We appreciate your candid comments, whether favorable or unfavorable.  

Thank you for your time.

Heather M. Moulden, Ph.D., C. Psych.
Membership Committee Chair


Who is this reference for?

By completing this reference letter form, I understand that the person named above has applied for membership in the Association for the Treatment of Sexual Abusers (ATSA) and has requested that I provide a confidential statement regarding the applicant's professional and ethical qualifications.
I certify that the answers and statements provided below are true and complete.

To the best of your knowledge has the applicant ever been accused, investigated, and/or involved in unprofessional, illegal, or unethical conduct?

If “Yes”, please include a complete explanation

Please complete the following Reference information.

How long have you known the applicant and in what capacity?

Are you currently supervised or employed by the applicant?

Observations of the applicant’s work with sexual offenders:

Specific job duties performed by the applicant (including treatment philosophy, techniques):

Applicant's positive contributions to the field of sexual violence prevention:

Does the applicant demonstrate ethical integrity in professional and personal behavior?

In your opinion, is the applicant qualified by professional and ethical standards to be a member of ATSA?

Additional Comments?