Supervisee Application

Part-time fee-for-service positions will be open starting in September and October of 2019.
If you are an LMSW in search of supervised hours toward your LCSW, or a therapist with another type of license seeking supervision and further training focused on non-mainstream identifications and relationships, 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.

Please note: You won’t be entering into an immediately full case load, which means there may not be immediate income. There may or may not be clients on a waiting list that you can begin working with right away, and we’ll work together to build your case load.

*if different than above
Phone *
Phone
Address *
Address
Please note where you received your MSW (or other licensure program) and your date of graduation. (Pending dates are also fine.)
Please note your LMSW, LCSW, or other type of practitioner license number, and state and date of licensure. If you are not yet licensed but plan to take the LMSW or other type of licensure exam soon, please note your exam date. If we meet for an interview, I will ask you to provide verification 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.