HiBHC Student / Pre-licensed Interest Form

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Thank you for your willingness to join the connection.

This form is for behavioral health student clinicians - all disciplines are welcome! We seek to match students and pre-licensed colleagues with continuing education and volunteer opportunities, as well as coordinate training, supervision, community events, and organizational collaborations.

This form is also for pre-licensed or unlicensed allies and colleagues (e.g., CHWs, CSACs, traditional healers) who make daily differences in the community!

We will not publish or share your responses or contact information without your active consent if/when a request comes in and a match is made.

If you have any questions about this form, please contact HiBHCoutreach@gmail.com

Email *

First name(s) *

Last name(s) *

What type of program are you in? *

Psychology (Ph.D.)

Psychology (Psy.D.)

Social Work (LCSW)

Marriage and Family Therapy (LMFT)

Counseling (LMHC)

Bachelor's program (BA/BS)

Other:

Required

Please indicate the name of your school. *

Are you a current member of the Hawaii Psychological Association? *

Yes

I don't know

Other:

Are you looking to be connected with clinical supervision? *

Yes

Your primary physical location *

Maui

Hawaiʻi

Kauaʻi

Lānaʻi

Molokaʻi

Oʻahu

Other:

Would you like to receive updates on volunteer opportunities and CE offerings? *

Yes

What kinds of volunteer opportunities are you interested in? *

In person events

Virtual events

Clinical support (in person)

Administrative tasks

Required

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