Lifelong Wellness Center Counseling, PLLC Intern Questionnaire
This questionnaire is intended for individuals interested in clinical mental health counseling and/or school counseling, and is offered to those enrolled in a program, organization, university, or those seeking more clinical experience in the field of psychotherapy for children and families. Interns are unpaid. If you are seeking employment, please email your resume to info@lwccounseling.com. Thank you!
Email *
Full Name *
Email Address *
What is the name of your institution, program, or organization that you are enrolled in? If you are not enrolled in a program, please type "N/A." *
If you are a licensed provider, please provide your state's credentials and license number(s), otherwise, type "N/A" *
Platforms for Services Preferred *
Required
Home Address *
Phone Number *
Clientele Experience *
Required
Additional Certifications and Specialties
Paneled with Insurance Carriers *
Required
Are you a Registered Play Therapist/Supervisor with the Association for Play Therapy? *
Availability *
Required
What is your preferred clientele's presenting concern and age range? *
For Associate Clinicians, how many hours remain for your full licensure in CT?
What are the supervision requirements at your program? *
Is virtual supervision allowed toward your required supervision hours? *
Are you allowed to provide virtual services for direct hours? *
How many group supervision hours can be used to fulfill your requirements? *
Please provide your program's definition of indirect and direct hours and the regulations of face-to-face participation with clients. *
Are you allowed to have more than one internship site location? *
Are you allowed to have more than one site supervisor for your internship, other than the supervision through your program? *
Email your resume to info@lwcounseling.com. Thank you for your interest and we look forward to connecting soon!
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