Training Registration

MACES Clinical Supervision Training Registration. Please complete the entire form and click submit. Completion of this registration form equals 1 hour of training. You can pay for the training on the confirmation page after you complete this registration. Registration is not final until we have received payment in full. If you experience any difficulties please email us at michiganaces@gmail.com or call Vicki Sepulveda, MACES President at 313-578-0468.

PLEASE NOTE: YOU MUST EITHER BE LPC ELIGIBLE (ATTAINING LICENSURE WITHIN ONE MONTH OF THE TRAINING) OR ALREADY LICENSED AS A LPC IN ORDER TO TAKE THIS TRAINING.

* Indicates required field

Name *

First

Last

Email *

Address *

City, State & Zip code *

Home or Cell Phone *

License Type *

License # *

Years of clinical experience *

Michigan Counseling Association Member? *

Yes No

If Yes, please provide membership # *

Do you have prior experience as a supervisor? *

Yes No

Please describe your clinical specialty *

Write a self reflection (300-500) words about your personal clinical supervision experiences *

Why are you a clinical supervisor or why do you want to become a clinical supervisor? *

What are your learning goals for this training? Please include at least three. *

Submit