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School Behavioral Health (SBH) Peer Mentor Program
Mentee Application
General Information
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1.
First name
(Required.)
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2.
Last name
(Required.)
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3.
Email
(Required.)
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4.
School
(Required.)
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5.
Role
(Required.)
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6.
Indicate your licensures/credentials (check all that apply)
(Required.)
Doctor of Psychology (PsyD)
Licensed Graduate Professional Counselor (LGPC)
Licensed Graduate Social Worker (LGSW)
Licensed Independent Clinical Social Worker (LICSW)
Licensed Professional Counselor (LPC)
Licensed Psychologist
Psychology Associate
Psychology (Ph.D.)
School Counselor
School Psychologist
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7.
How long have you been in school-based behavioral health?
(Required.)
0-2 years
3-4 years
5-6 years
7+ years
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8.
Select the organization of your employment
(Required.)
DC Public School (DCPS)
DC Public Charter School
Community-Based Organization (CBO)
Department of Behavioral Health (DBH)
In two to four sentences, please answer the following questions.
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9.
Please provide some details about your professional journey/experience.
(Required.)
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10.
Why did you choose to be in school-behavioral health?
(Required.)
