Triadic Supervision CE Workshop Events Online CE Workshops Supervision Services Therapist Support Triadic Supervision Indicate your choice of supervision services from the options below. * indicates required field (2 clinicians + supervisor) Sessions must be completed within a consecutive 12-month period 1 - 55 min session per mo (1st or 3rd week of the mo.) $100/session/person. 12 payments auto-billed @ $100 per mo/person2 - 55 min sessions per mo (1st & 3rd weeks of the mo). $70/session/person. 12 payments auto-billed @ $140 per mo/person2 - 75 min sessions per mo(1st & 3rd weeks of the mo). $90/session/person. 12 payments auto-billed @ $180 per mo/person First Name * Last Name * Address Line 1 * Address Line 2 City * State * Zip * Email Address * Mobile Phone * Work Phone Highest Degree Completed * MAMSMCMHMFTPhDOther Degree Major * Indicate all other degrees earned with accompanying majors I am * Currently Seeking LicensureAlready LicensedNot Licensed, but plan to Current Licenses LAPCLPCAMFTLMFTLCSWNONE If not yet licensed but you are planning to be, indicate which of the following applies to you. Check all that apply NCE passedNCE to be takenNCMHCE exam passed NMHCE exam to be taken MFT exam passedMFT exam to be takenLAPC / AMFT application sent to the boardLAPC / AMFT licensure information begin collected but not sent to the board Place of Employment * Address Line 1 * Place of Employment * Address Line 1 * Address Line 2 City * State * Zip * Describe your clinical setting - including size of organization, population, typical, and daily activities Attach Resume Please describe what you are looking for within supervision relationship I confirm that the information provided above is true and accurate.