Volunteer Application Form for Psychologists of Color, Inc
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Name *
Email address *
Phone number *
Preferred method of contact *
Which of the following best describes you? *
If Multiracial or Biracial, please provide additional information here.
What is your age? *
Location *
How far along are you in your career journey? *
Required
What school(s) did you attend? *
Please list any additional certifications in the mental health field.
Are you currently licensed in any states? If so, please list them. *
If you are licensed, how long have you been licensed?
What are your areas of expertise, specialty, or interest? *
Required
What is your primary work setting? *
Required
Current job title/role. *
Do you have experience working with groups? *
Have you ever provided supervision or consultation services? *
Which age group(s) do you serve or do you plan to serve? *
Required
Outside of the pandemic, do you primarily work in-person or virtually? *
Required
In which of the following volunteer opportunities are you most interested? *
Required
Theoretical Orientations *
Required
How frequently do you hope to be able to volunteer? *
Required
Please provide your general availability. *
How did you hear about POC, Inc? *
Is there any other information you would like us to know to help link you with volunteer opportunities through Psychologists of Color, Inc.? *
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