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MICHIGAN ASSOCIATION FOR COUNSELOR EDUCATION & SUPERVISION
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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
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City, State & Zip code
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Home or Cell Phone
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License Type
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LLPC
LPC
Other
License #
*
Years of clinical experience
*
Michigan Counseling Association Member?
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Yes
No
If Yes, please provide membership #
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Do you have prior experience as a supervisor?
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Yes
No
Current Placement Setting
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Community/Mental Health Agency
Pre K- Elementary School
Middle School
High School
Community College
College/University
Private Practice
Hospital
Addictions Agency
Not currently in field
Choose all that apply
Current Population
*
Children
Adolescents
Adults
Couples
Families
Choose all that apply
Please describe your clinical specialty
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For example, addictions, depression, play therapy etc.
Write a self reflection (300-500) words about your personal clinical supervision experiences
*
This question is copyrighted by S. Manoogian (2012. All rights reserved.
Why are you a clinical supervisor or why do you want to become a clinical supervisor?
*
This question is copyrighted by S. Manoogian (2012. All rights reserved.
What are your learning goals for this training? Please include at least three.
*
This question is copyrighted by S. Manoogian (2012. All rights reserved.
Submit