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Social Workers Who Are Offering Pro-Bono Services
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First Name
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Your answer
Last Name
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Your answer
What is the name of your practice?
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Your answer
Are you virtual or in-person?
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Virtual
In-Person
Both
Other:
If In-Person, what is your business address?
Your answer
Are You A Licensed Clinical Social Worker (LCSW) in California?
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Yes
No
If no, What are your credentials?
Your answer
If you are an ASW in California, please provide the name and license number of your supervisor
Your answer
Do you have malpractice insurance?
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Yes
No
Do you speak any additional languages?
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Yes
No
What other languages do you speak?
Your answer
How many clients or families are you willing to serve?
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Your answer
How long are you willing to serve? (Months or a number of sessions)
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Your answer
How can potential clients contact you?
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Your answer
Please provide your website (ex: Psychology Today, Personal Website, etc).
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Your answer
Services You Can Offer For FREE
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Individual Therapy (adults)
Individual therapy (teens ages 12-18)
Individual Therapy for children (under 12)
Couples Therapy
Family Therapy
Support Group
Other:
Required
Additional Services You'd Like To Provide
Your answer
Can you please describe your specialty of the clients that you serve?
*
Your answer
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