Bay Area Asylum Mental Health Project Training/Network Application for *Licensed Clinicians*
The Project invites *licensed* mental health clinicians to join us. Clinicians must have professional liability insurance in order to conduct asylum evaluations. Once we receive your application, we will add you to the waiting list for training. Training sessions are offered several times a year in the Bay Area. We will also assign a mentor to work with you on the first two evaluations. We look forward to seeing you soon at one of our trainings.
Email *
Name *
Last Name *
Address *
City *
State *
ZIP Code *
Work Phone Number (OK to provide to clients and referring attorney) *
Cell Phone Number (for use by Project personnel only) *
Never submit passwords through Google Forms.
This form was created inside of Research Institute Without Walls. Report Abuse