Supervision Retreat Waitlist Registration Series Part 3 - July 1st, 2023
You must be an OHIO licensed Social Workers, MFT, or LCDC to attend this supervision retreat. You will be invoiced ahead of time $140. Payment is due to reserve spot. 
Email *
Name *
Email Address *
Please note you must be licensed in Ohio with either an LSW, LCDC (CDCA-LCDCIII), or MFT licensed practitioner in order for these hours to count towards licensure. *
Current Job Title *
General Job Description *
Employer with City & State *
Are you engaged in Masters level social work at your above agency? *
As part of your practice, are you engage in Counseling (e.g. giving feedback, delineating alternatives, helping articulate goals, providing needed information) while under supervision? *
As part of your practice, are you engage in Psychosocial Intervention (e.g. family systems therapy, group interventions, environmental modifications) while under supervision? *
As part of your practice, are you engage in Psychosocial Intervention at the administrative level (e.g. client centered advocacy, community organization, organizational change) while under supervision? *
As part of your practice, are you engage in Social Psychotherapy (e.g. assessment, diagnosis, treatment, psychotherapy, consultation, evaluation, interventions directed to interpersonal interactions) while under supervision? *
Who is your clinical supervisor? Full Name *
You are aware this is a 1 day supervision and does not constitute a full training supervision agreement for ongoing supervision. *
What are you hoping to get out of this supervision retreat? *
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