AASECT BIPOC Supervision Introduction
BIPOC Clinicians seeking a primary or secondary supervisor for AASECT Certification 
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Email *
Name *
Pronouns *
Current credentials (e.g. licensure, state of licensure) *
Are you seeking AASECT Supervision? *
Are you currently under supervision with another AASECT Supervisor? *
If yes, who is your current AASECT Supervisor? *
Are you currently under supervision with another  Non-AASECT Certification Supervisor? *
If yes, what is the purpose of your supervision (e.g. licensure, certification)? *
What type of supervision are you looking for? *
Required
If group, which group offering are you interested in joining? *
What is your desired start date? *
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Are you currently enrolled in a sex therapy certification program or school for a sex therapy degree? *
Required
Which program or school? *
Do you identify as LGBTQIA2+AA *
Do you identify as Black, Indigenous, or Person of Color? *
What languages do you speak?  What is your preferred language to communicate with? *
Do you serve clients that speak another language? *
What language do they speak?  Do you also speak your client's language? *
What kind of clients are you currently working with?  What kind of clients would you like to serve? *
What is your specialization? *
What are your goals for supervision? *
Do you have any questions for me? *
How did you hear about Jacqueline? *
A copy of your responses will be emailed to the address you provided.
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