*1.Which state are you licensed to practice as a licensed professional counselor?(Required.)

Texas

Tennessee

Florida

South Carolina

Louisiana

Oklahoma

Arkansas

Mississippi

Alabama

Kentucky

West Virginia

Virginia

Maryland

Delaware

Washington D.C.

North Carolina

Georgia

None of the Above

*2.Have you currently or previously provided treatment to Black Americans?(Required.)

Yes

No

*3.Are you a licensed social worker, psychologist, or psychiatrist?(Required.)

Yes

No

*4.Are you a licensed professional counselor who work solely with clients that present with severe or persistent mental illness?(Required.)

Yes

No