Thank you for reaching out regarding your interest in supervision. Please respond to the following questions prior to our initial meeting where we can discuss further if we would be a good fit.

Supervision Application

Name

First Name

Last Name

Email

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Subject

What are your goals for supervision?

What draws you to supervision with me?

What counseling theories interest you?

What populations are you hoping to work with?

What supervision experiences have been most useful to you in the past?

What supervision experiences have not been helpful?

Where are you currently working?

Briefly describe your short-term and long-term career goals.

Briefly describe the qualities of your ideal supervision.

**If you are transitioning from another supervisor, be sure that your current supervisor fills out a final supervision report and submits it to the board. I will need a copy of this report. I also need a release of information signed to communicate with this supervisor.