Group Supervision Waitlist
Please complete this form if you are interested in joining our group supervision sessions and someone from our team will contact you.
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Name (First & Last) *
Phone Number *
Email Address *
Current Licensure Level (LMSW/LGPC) *
How long have you held this license? *
What states are you licensed in? *
When are you planning to sit for your clinical license? *
How long have you been practicing in your field? *
Do you receive individual supervision? *
If yes, to the previous question, who is your supervisor? (Name, agency & contact info.) *
What timeframe works best for you in regards to attending group supervision? *
Required
Briefly explain what you are looking for when it comes to your group supervision experience: *
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