We require that site supervisors complete this form.  Thank you!

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* 1. Please provide your contact information

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* 2. What graduate degree do you hold?

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* 3. What license do you hold?

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* 4. For how many years have you been licensed?

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* 5. For how many years have you been working with the population/issues that are present at your site?

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* 6. For how many years have you supervised master's level mental health trainees?  (Practicum, Internship, Associates)

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* 7. Please describe any coursework, continuing education sessions, reading, or other training you have had in supervision.

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* 8. Supervisors of our practicum students are required to either record or directly observe the student's work with clients at some point during practicum (we recommend especially in the early stages).  Supervisors of interns are strongly encouraged to do so also.  Are you prepared to do this?

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* 9. Please upload a copy of your CV or resume here.

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* 10. Please upload a picture or a copy of your current license

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* 11. Please verify that you have completed all the components of the site supervisor training posted on the Westminster MSMHC website.

Thank you for supervising our student.   Please contact us if you have any questions or concerns.   We look forward to working with you.

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