Site Supervisor Data Form and Training Confirmation
Thank you for taking the time to support our students by serving as a site supervisor. As a part of our CACREP requirements, we must collect specific demographic information about our site supervisors. The information collected will be shared in our CACREP re-accreditation report. Please complete the information below to the best of your ability. You may email the Clinical Coordinator, Tameka Grimes, at togrimes@vt.edu or Course Instructor if you have any questions.
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Email *
What is your name? *
What is your highest degree earned? *
What is the formal name of your degree (ex. Counseling, School Counseling, Counselor Education, Counseling Psychology, Social Work, etc)?
Which license(s) do you hold? *
Required
Do you hold any of the following certification(s)?
How many total years have you worked as a counselor (clinical and/or school)? *
Have you previously served as a site supervisor (for any counseling program)? *
If applicable, please describe any supervision training you have done (coursework or professional development).
Are you an alumnus of the Virginia Tech counseling program (MA or PhD)?
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Did you attend the Internship Orientation and Supervision Training? *
If you did not attend the Internship Orientation and Supervision Training, please affirm the following statement by selecting the radio button below: I certify that I have reviewed the training material on the On-Site Supervisor webpage.
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