Clinical Supervision Inquiry Form

Full Name *

First Name Last Name

E-mail *

Phone Number *

Area Code Phone Number

What type of supervision are you seeking? *

NEW LPC Associate Supervision Transitioning LPC Associate Supervision None; Seeking contract employment opportunities only

What is/are your theoretical orientation(s) you have a passion for and why? *

What is your Counselor Identity? *

Did you attend a CACREP University? *

YES NO

Have you or when will you complete your NCE Exam? If not, what date do you expect to sit for your exam? *

Do you have a clinical site in mind (Please specify if applicable)? *

Are you interested in joining Counseling Connections of San Antonio/Franklin Training & Consulting, Inc (Group Practice) [Optional for LPC Associates]? *

YES NO MAYBE OTHER

When are you seeking to apply for licensure? *

References (Please list three references with name, email address, and phone): *

NOTE: DO NOT USE FRIENDS OR FAMILY.

Best day/time to be contacted?

Month Day Year Hour Minutes AM/PM Option

Upload Resume *

Note: This is NOT for employment. This inquiry screen is ONLY to request LPC Supervision for the purposes of state licensure in Texas.

If you have NOT received contact within THREE business days from submission, please CALL and leave a voiemail at 210-446-8255.

Additional Resources:

Supervisor(s):

https://www.psychologytoday.com/us/therapists/supervision-services

Military Spouses (Supervision Reimbursement):

https://www.militaryfamily.org/licensing-certification/

Veterans (Licensing Exam Reimbursement):

https://www.vba.va.gov/pubs/forms/VBA-22-0803-ARE.pdf