Application for CAPT Supervision Group - Fall cohort Question Title * 1. Name Question Title * 2. Email Question Title * 3. Membership status with CAPT Full member Student If you are a student, what is your level of study? Question Title * 4. Regulatory status Registered psychotherapist Registered psychotherapist, Qualifying Not yet achieved independent practice status Other If other, please list your status/designation here Question Title * 5. Do you have a psychodynamic background or training? Yes No If yes, please provide details such as experience and education. Question Title * 6. Are you familiar with group supervision? Yes No Question Title * 7. Are you following regulatory requirements for direct client contact hours within individual or dyadic supervision? Yes No Question Title * 8. Have you obtained professional liability insurance? Yes No Question Title * 9. If you were to participate in group supervision, what would you like to accomplish? Question Title * 10. Do you consent to completing an evaluation at the middle and end of the group? Yes No Question Title * 11. Do you consent to attending a Meet and Greet session prior to the group starting? Yes No Question Title * 12. Cancellation Supervisees are required to agree to a cancellation policy of two sessions, after which they must stay in the cohort. Supervisees who wish to withdraw must do so prior to the third session. This allows CAPT to make any necessary adjustments to ensure the continuity and cohesion of the group. I agree I do not agree Question Title * 13. DisclaimerBy participating in this supervision group, I acknowledge that the material is for supportive and educational purposes only and that CAPT is not responsible for individual outcomes. By submitting this application, I understand that CAPT is not responsible for the content, material, or outcome within supervision with the clinical supervisor.Opinions or points of view expressed represent the view of the supervisor. At all times, CAPT directs its members to seek guidance, advice and training from the appropriate accredited sources.I also agree that group supervision does not meet the requirements for direct client contact hours.I agree that, should a complaint arise, CAPT will not be responsible for mediating issues between the supervisor and member. I agree with this disclaimer I do not agree with this disclaimer Thank you for your application. Done