Let’s work together.Interested in working together? Fill out some info and we will be in touch shortly! We can't wait to hear from you! Name * First Name Last Name Primary Email (school/personal) * Alternate Email Phone * (###) ### #### Which time listed is ideal for your supervision? (Note: there may be more than one request for the same day and time. We will try to fit your preferred time and cannot gurantee the time you chose is available.) * Monday 1:00 – 2:00 PM Monday 2:00 – 3:00 PM Monday 3:00 – 4:00 PM Tuesday 1:00 PM to 2:00 PM Tuesday 2:00 PM to 3:00 PM Tuesday 3:00 PM to 4:00 PM Tuesday 5:00 PM to 6:00 PM Tuesday 6:30 PM to 7:00 PM Wednesday 1:00 PM to 2:00 PM Wednesday 2:00 PM to 3:00 PM Wednesday 3:00 PM to 4:00 PM11 Wednesday 5:00 PM to 6:00 PM Wednesday 6:30 PM to 7:00 PM Thursday 1:00 PM to 2:00 PM Thursday 2:00 PM to 3:00 PM Friday 1:00 PM to 2:00 PM Friday 2:00 PM to 3:00 PM Other (I will speak with my supervision about my supervision needs) What institution do you attend? What year in your program are you? 1 st year Counseling 1 st year Social Work 2 nd year Counseling 2 nd year Social Work Peer Observation Other Message * Do you already have an assigned supervisor for the coming year? If so, indicate here; Kenneth Winfrey, LCSW Jay Blackwell, LMHC Alexandria Askew, LMSW Lyric Lawson-Parks, LCSW Steven DeAnda, LMSW Carmella Giaquinto, Operations Manager First Day of School/Placement * MM DD YYYY Site Visit Date (if scheduled) MM DD YYYY Midterm Due Date MM DD YYYY Final Exam Date MM DD YYYY Winter Break Begins MM DD YYYY Last Day of Placement (e.g., end of Second Semester) MM DD YYYY Number of Supervision Hours Required Per Week Number of Practice Hours Required Per Week Checkbox Mondays 9:30 AM to 10:30 AM 🧘 Kemetic Yoga for Mind-Body Alignment (In-Person, Group) Mondays 10:30 AM to 11:15 AM 🧠 BSA Workshop: Transforming Core Beliefs (In-Person, Group) Mondays 11:15 AM to 12:15 PM 🧍♂️ Individual Therapy – 3 private slots (In-Person) Mondays 12:15 PM to 1:15 PM 🍲 Mindful Lunch & Journaling (In-Person) Mondays 1:15 PM to 2:15 PM 💬 Process Group: Coping with Triggers (In-Person, Group) Mondays 3:15 PM to 4:30 PM ☕ Mindfulness, Coloring, & Integration Time (In-Person) Mondays 5:00 PM to 6:00 PM 🌱 Evening Meditation Circle (Online, Group) Mondays 7:00 PM to 8:00 PM 💬 Online Process Group: Identity After Trauma (Online, Group) Tuesdays 9:30 AM to 10:30 AM 🔄 Bilateral Grounding for Nervous System Reset (In-Person, Group) Tuesdays 10:30 AM to 11:15 AM 📚 Trauma Recovery Skills & Education (In-Person, Group) Tuesdays 11:15 AM to 12:15 PM 🧍♂️ Individual Therapy – 3 private slots (In-Person) Tuesdays 12:15 PM to 1:15 PM 🍲 Lunch & Independent Project Time Tuesdays 1:15 PM to 2:15 PM 🎭 Storytelling Circle: Voices of Resilience (In-Person, Group)Option 13 Tuesdays 3:15 PM to 4:30 PM ☕ Mindfulness, Coloring, & Integration Time (In-Person) Tuesdays 5:00 PM to 6:00 PM 🎙️ Peer-Led Topic Chat: “Resilience” (Online, Group) Tuesdays 7:00 PM to 8:00 PM 🧠 CBT Tools for Flashbacks (Online, Group) Wednesdays 9:30 AM to 10:30 AM 🧘 Yoga & Mindful Check-In (In-Person, Group) Wednesdays 10:30 AM to 11:15 AM 🎨 Art & Emotion Processing (In-Person, Group) Wednesdays 11:15 AM to 12:15 PM 🧍♂️ Individual Therapy – 3 private slots (In-Person) Wednesdays 12:15 PM to 1:15 PM 🍲 Lunch & Grounding Practice Wednesdays 3:15 PM to 4:30 PM ☕ Mindfulness, Coloring, & Integration Time (In-Person) Wednesdays 5:00 PM to 6:00 PM ✍️ Expressive Writing: “Unwritten Letters” (Online, Group) Wednesdays 7:00 PM to 8:00 PM 💡 Discussion: Integral Practice in Daily Life (Online, Group) Thursdays 9:30 AM to 10:30 AM 🚶♀️ Walking Group / Nature Therapy (In-Person, Group) Thursdays 10:30 AM to 11:15 AM 🤝 Interpersonal Skills & Boundaries (In-Person, Group) Thursdays 11:15 AM to 12:15 PM 🧍♂️ Individual Therapy – 3 private slots (In-Person) Thursdays 1:15 PM to 2:15 PM 🎨 Expressive Journaling (In-Person, Group) Thursdays 3:15 PM to 4:30 PM 🥁 Drumming & Movement for Connection (In-Person, Group) Thursdays 5:00 PM to 6:00 PM 🎧 Sound Bath & Music Sharing (Online, Group) Thursdays 7:00 PM to 8:00 PM 🧭 Values Clarification & Meaning-Making (Online, Group) Fridays 9:30 AM to 10:30 AM 🧠 Breath & Intention Setting (In-Person, Group) Fridays 10:30 AM to 11:15 AM 📋 Recovery Planning for a Balanced Life (In-Person, Group) Fridays 1:15 PM to 2:15 PM 💡 Week in Review 4-Agreements Group (In-Person, Group) Fridays 3:15 PM to 4:30 PM ☕ Mindfulness, Coloring, & Integration Time (In-Person) Fridays 5:00 PM to 6:00 PM 🧘♀️ Kemetic Yoga Flow (Online, Group) Fridays 7:00 PM to 8:00 PM 🤝 Peer Story Share & Feedback Fridays 7:00 PM to 8:00 P🪜 16 Steps Recovery (Online, Group) Saturdays 9:30 AM to 10:30 AM 🤝 Healing Circle for Connection & Renewal (In-Person, Group) Saturdays 10:30 AM to 11:15 AM 🧘 Nature Yoga Therapy / Movement Integration (In-Person, Group) Saturdays 12:15 PM to 1:15 PM 🎓 Adjourn for Weekend Thank you!
