ALC Supervisee Interest Form
Please complete if you are interested in working with Alicia Winkle for supervision.
* Required
Email address
*
Your email
What is your name (first and last)?
*
Your answer
Phone number?
*
Your answer
What city in Alabama do you reside?
*
Huntsville, AL
Madison, AL
Athens, AL
Other:
How did you hear about me?
*
Your answer
Have you completed your Master's degree?
*
Yes
No
What is your degree?
*
Your answer
When would you like to start hours for your ALC?
*
MM
/
DD
/
YYYY
What is the site where you will be working to accumulate hours for your ALC?
*
Your answer
Will your site allow an LPC-S on site to review client charts and meet with you for supervision as needed?
*
Yes
No
What populations are you most interested working with?
*
Trauma/Abuse/PTSD
Sex Offenders
Anxiety Disorders
Other:
Required
Are you dedicated to 2 full years of consistent supervision at this time?
*
Yes
No
Maybe
Send me a copy of my responses.
Submit
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