Michigan Association for Infant Mental Health
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ECLS.2022.1.13.Supervisor Series
ECLS.2022.1.13.Supervisor Series
4 available
Name
*
First
Last
Email (you will receive a confirmation email using this entry)
*
Agency/Organization
*
Cell Phone (emergencies only)
*
Are you a Licensed Social Worker or Licensed Professional Counselor?
*
Yes
No
License Number (required for continuing education)
*
What is your level of endorsement, if applicable?
*
Infant Family Associate
Waiver
Infant Family Specialist
Infant Mental Health Specialist
Infant Mental Health Mentor
Not Applicable
Please indicate your discipline
*
BA
BS
BSN
BSW
EdD
LP
LPC
MA
MEd
MS
MSW
MSN
PsyD
PhD
How many years have you been supervising IMH clinicians?
*
Under a Year
1-5 years
6-10 years
11-15 years
16-20 years
21 years +
How many people do you supervise in an IMH setting?
*
1-5
6-10
11-15
16-20
21 +
Select ALL of the training dates you will be attending for the supervisor series
*
Select All
January 13th 9am - 12pm
February 10th 9am - 12pm
March 17th 9am - 12pm
April 14th 9am - 11am
What are you hoping to gain from this training?
What questions do you have for the trainer(s)? These will be given to the trainers before the training day.
ECLS.2022.1.13.Supervisor Series quantity
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