Advanced Clinical Practicum

Name *

First Name

Last Name

Phone *

(###)

###

####

When is your expected graduation date? *

MM

DD

YYYY

When did you graduate? *

MM

DD

YYYY

Starting Date *

MM

DD

YYYY

End Date

MM

DD

YYYY

The nature of private practice work often falls outside of regular 9-5 business hours. Please consider if you able and willing to accommodate a schedule that would include at least 1-2 evenings until 8pm and/or on a weekend day. *

Yes, I am willing and able to accomodate evening and or weekend hours.

In addition to individual supervision, all Repose therapists take part in weekly group supervision, held on Mondays at 12 PM ET. As an ACF, your participation in these meetings is expected and valued. Please let us know if you can guarantee that your schedule will consistently allow you to attend at this time each week. *

I am available to attend weekly group supervision on Mondays at 12PM ET.

This practicum experience requires a high level of professional acumen and the ability to work autonomously. You would be required to perform virtual therapy sessions over a secure video platform from a professional appearing, confidential, and quiet location. You understand that supervision will also be facilitated virtually. *

Yes, I understand and can meet these requirements.

Our expectation is that you will familiarize yourself with the content on our website prior to an interview. *

I understand and agree to prepare in advance of an interview.

Commitment to Repose Vision & Values *

We strive to create a workplace culture that is supportive, dynamic, and growth-oriented. The exceptional clinicians who join our team are deeply passionate about our mission, committed to our values, and are dedicated to their professional development within Repose. Does this resonate with you?

This resonates with my intentions.