Play Therapy Supervision Application
Please complete the following application to be considered for an individual and/or group supervision slot. Once your application has been submitted, Michael will be in touch with next steps! Supervision is eligible towards APT credentialing requirements.
* Required
First & Last Name
*
Your answer
Email
*
Your answer
City & State
*
Your answer
Phone Number
*
Your answer
I am interested in:
*
Individual Supervision ($100/hour or $90/hour for cohort members)
The 2019-2020 Group Cohort ($65/session or $325/cohort)
Required
Will you be providing play therapy services during the course of the group (2019/2020)?
*
The Association for Play Therapy requires experience be concurrent to supervision hours.
Yes
No
Do you have access to high-speed internet and camera/microphone devices on your computer?
*
Yes
No
Maybe, I need some help figuring that out.
Do you have a current Montana license (LCPC, LCSW, or LMFT)?
*
Yes
No
Not yet, but in the process
I am licensed in another state.
Submit
Never submit passwords through Google Forms.
This form was created inside of Relating Play.
Report Abuse
Forms
