Mental Health Supervision & Training Interest
Welcome!

If you are interested in internship, licensure, or continuing education hours, you are in the right place.  Complete the general interest form below to be contacted by our team who can help you define and satisfy your supervision needs.  Our mental health supervision training and courses are hosted by Clinical Supervision professional, Carolyn Simms, LCPC.  

Carolyn Simms is licensed in the state of Maryland as a Clinician and a Supervisor to LGPC's by the Board of Professional Counselors and Therapist (BOPC).  She also holds a Certified Addictions Counseling credential from Bowie State University (Bowie, Maryland) as well as a Technology Entrepreneurship degree from University of Maryland (College Park, Maryland) alongside her Psychology degrees.  Carolyn received a Bowie State Affiliation to certify the hours of interns and student trainees and is currently accepting individual trainees, groups, and institutional partnerships.

Please feel free to contact me at the office 301-459-0708 for interview after completing this form.
Sign in to Google to save your progress. Learn more
Email *
Last Name: *
First Name *
Phone number *
What is your current level of education in the Mental Health field? *
Required
In short, What is it that you want to gain, learn, or experience from working with Carolyn Simms?
What school do you attend,  have attended, or plan to attend.  Please indicate your status. *
What is your interest? *
Do you have any mental health organization affiliations or memberships?  This can include student, professional, and non profit groups. *
If you have questions or comments please note them here.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of yoursafespace.org. Report Abuse