Virtual supervision Inquiry

Virtual Supervision Inquiry

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Virtual Supervision Inquiry

Inquiry

ROOTED Virtual Supervision

We provide both individual and group supervision for those who do not yet have independent licensure but are working toward licensure (this offering is for LGPC practitioners).

Name

Date of Birth

Phone Number

City, State

Degree

Specialization

License Number

Current Employer / Educational Institution

Years of Experience in the Field

Reasons for Seeking Virtual Supervision

Preferred Communication Tools for Virtual Sessions

Current Professional Status

Availability for Supervision Sessions

Mondays Tuesdays Wednesdays Thursdays

Thursdays Mornings 9am-11am Afternoons 12-3 Evenings 4-7

Flexible

Professional Goals and Expectations from the Supervision

Any Specific Areas of Focus or Development Desired

Previous Supervision Experience (if any)