What is Boost 200?

Boost 200 is a special initiative to accelerate licensure of 200 Masters-prepared individuals pursuing licensure in Virginia as a Licensed Professional Counselor (LPC)  or Licensed Clinical Social Worker (LCSW) by paying for their required Supervision hours.
 
The ideal Boost 200 candidate is a recent MC or MSW graduate or a Supervisee in Social Work/Licensed Resident in Counseling pursuing licensure as a Licensed Professional Counselor or Licensed Clinical Social Worker in Virginia, and who is:
  • Paying out-of-pocket for some or all of their Supervision and
  • Prepared, motivated, energetic, and ready to complete their clinical and Supervision hours.
This Recommendation Form should be completed by someone who has supervised the Boost 200 applicant for at least 100 internship hours and familiar with the applicant's current
clinical skills and experience.
 
A completed recommendation form is required for all Boost 200 applicants.
 
 

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* 1. Your Information:

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* 2. Boost 200 Applicant's Information:

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* 3. What type of degree does the Boost 200 applicant hold?

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* 4. How long have you known the Boost 200 applicant?

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* 6. On the scale below, please rate the applicant relative to other recent Counseling or Social Work graduates (or Supervisees/Residents in Counseling) you know who are pursuing licensure in Virginia.

  Exceptional 
(Top 2%)
Excellent 
(Top 5%)
Very Good 
(Top 10%)
Good
(Top 25%)
Average
(50%)
Poor
(Below 50%)
Motivation and Energy to Become Licensed
Ability to Work Autonomously
Ability to Work with Other Health Professionals
Emotional Maturity
Professionalism
Clinical Ability
Dependability
Ability to Manage Stress
Ability to Communicate Effectively

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* 7. Please indicate your recommendation of the applicant for Boost 200:

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* 8. Optional: You are welcome to provide a narrative in support of the applicant's application for Boost 200. If you would like to submit a written assessment to complement the required chart, please provide on a separate page (limited to 1-page double spaced, Arial, 12-pt. font)

PDF, DOC, DOCX file types only.
Choose File

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* 9. By checking "I agree" below and clicking "Submit" below, you are indicating that you have completed the Boost 200 recommendation form on behalf of the applicant accurately to the best of your ability.

Boost 200 is a special initiative of the Virginia Health Care Foundation,
funded by the Virginia General Assembly and the Virginia Department of Behavioral Health and Developmental Services.

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