Post-Graduate Residency application form
Thank you for your interest in the Post-Graduate Residency position. This role is for recent master's level graduates in the mental health field looking to gain experience and fulfill their hours for clinical licensure in the state of Illinois. 
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Personal Information
Name *
First and last name
Email *
Phone number *
Address *
Professional Experience
Please provide a brief description of your clinical practicum/internship (and work - if relevant) experience including what population(s) you served and other primary responsibilities.
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Describe any specialized training, skills, or therapeutic modalities you possess that are relevant to this position.
Desired Professional Experience
Siv is committed to providing high-quality training opportunities for our team of counselors at all levels of their professional development. The Post-Graduate Residency is specifically focused on the transition from counselor-in-training (CIT) to developing professional. Our hope is to provide you with a comprehensive learning experience that is also uniquely tailored to your passion and interests.  
What are your top three professional goals over the next two years?
What type of community engagement project would you be interested in developing? 
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Post-Graduate Residents work directly with our team to develop and execute various opportunities for community engagement in the area of mental health and wellness. We love empowering one another to build something they're excited about!
Ethical and Legal Compliance
Have you ever had a complaint filed against you with any licensing board or professional organization?
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If you answered "yes" to the above question, please provide details.
References
Please provide the names and contact information for two professional references as well as a pastor/spiritual mentor who can speak to your qualifications and suitability for this position.
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Additional Information
Is there anything else you would like us to know about you or your application?
Submit your cover letter or resume *
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