Supervision Introduction With Anne Mauro, LMFT, DHS, CSE, CST-S

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Hi, thanks for considering Anne Mauro as your supervisor. Anne provides AAMFT & AASECT CST Supervision and is based in Washington State. You can find out more information about supervision here: https://www.annemauro.com/clinical-supervision

After you complete this form, please schedule a free "Supervisory introduction" with Anne here: https://anne-mauro.clientsecure.me

*Here are the the AASECT supervision guidelines: https://www.aasect.org/guidelines-supervision

Email *

Name *

Pronouns *

How did you hear about doing supervision with Anne? *

What is your current credential? *

What type of supervision are you looking for? Please check all that apply. *

Washington State LMFT Supervision

AASECT Certified Sex Therapist (Primary Supervisor)

AASECT Certified Sex Therapist (Short Duration Supervisor)

AASECT Certified Sex Therapist (Group Supervision)

AASECT Cross Discipline (CSE/CSC) Up to 5 hours.

AASECT Sex Therapist in Training

AAMFT Supervisor Mentorship

Other:

Required

If yes, when would you like to start?

YYYY

Have you completed any of the Human Sexuality Education/Sex Therapy requirements? If so, please state where you are in the process and where you completed this training. *

Are you currently under supervision? *

Yes

If yes, please list your supervisor(s). *

Do you identify as 2SLGBTQIA+? *

Yes

Do you identify as Black, Indigenous, Person of Color, or Culture? *

Yes

Do you identify as being in another marginalized group not listed above? *

Goals for Supervision *

What is your specialization? What kind of clientele is your ideal? *

Do you have any questions for me? *

Please add 2 professional references name/phone/email *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Anne Mauro, PLLC. Report Abuse

Forms