Supervision Request

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Supervision Request

Thank you for your interest in supervision! This form is designed to help me better understand your needs, goals, and readiness for supervision. By completing it, you’ll provide valuable insight into how I can best support your professional growth and development.

Email *

Name (First and Last) *

Preferred method of contact: *

When are you looking to begin supervision? *

What is your ideal day/time that you are hoping to meet? *

Do you prefer to meet weekly or bi-weekly? *

Weekly (1 hour)

Bi-weekly (2 hours)

No preference

What type of license are you needing supervision for?

How many hours of supervision are you in need of? *

Supervision requires a commitment of time, effort, and financial investment. How prepared are you to prioritize and fulfill these responsibilities to support your professional growth? Please elaborate on your level of commitment and any factors that might impact your ability to fully engage in supervision.
*

Fully committed and ready to invest the necessary time and resources.

Somewhat committed but may need to address potential barriers (e.g., scheduling, finances).

Unsure about my readiness and would like to discuss further.

Supervision sessions are $130 per hour. Do you acknowledge and accept this financial responsibility as part of your investment in your professional growth?
*

Yes, I acknowledge and accept.

I acknowledge but would like to discuss further.

I have concerns about the financial commitment.

Please share any additional comments, questions, or concerns:

Submit

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