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I completed this form within the last six months, and my information has not changed. If Yes, please click submit. If No, please complete the remainder of this form. *
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I earned a minimum of a masters degree in counseling or a related educational field (e.g. psychology, social work, psychiatry, etc.) *
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I completed training in counseling supervision (e.g. graduate-level course, workshop, continuing education training, etc.). *
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I have worked at this site for a minimum of two years. *
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Certifications/ Licenses *
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I understand this is a legal representation of my signature.
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