Supervisee Application

Part-time fee-for-service positions will be open starting in September of 2019.
If you are an LMSW in search of supervised hours toward your LCSW, please fill out the form below.  I am seeking people who are looking to specialize in working with the most underserved sexuality and gender populations, including the trans/GNC/NB, LGBQ, BDSM/kink, poly/CNM, and sex work communities.  Priority will be given to those with intersecting identities in more than one of these populations.

*if different than above
Phone *
Phone
Address *
Address
Please note where you received your MSW and your date of graduation. (Pending dates are also fine.)
Please note your LMSW license number and date of licensure. If you are not yet licensed but plan to take the LMSW exam soon, please note your exam date. If we meet for an interview, I will ask you to provide proof of the scheduled exam.
Personal Identities/Affiliations (choose all that apply) *
Please indicate whether you are personally affiliated with any of the following identifications/communities/practices. (People who identify with multiple of the below will be given priority.)
Please note any internships, practicums, volunteer or other work you've done related to the populations listed above.
Please describe how this position will fit in with your current life and schedule, and support your goals.
Please describe how you would be a good fit for working with me and the populations my practice serves.
Please list your availability to see clients, noting any preferred days and times.