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Details

First name

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Last name

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Email address

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Where do you live?

Phone number for database managers to contact youMobile or landline, please include area code.

The purpose of collecting your phone number is for the database managers to contact you if necessary.

Phone number for listing publicly if you chooseMobile or landline, please include area code.

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Discipline

Service/organisation

Typical session length

minutes

The text you enter in the above text box will show on your public listing if you state a session length.

Your rate for a session of typical length

$

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Please add any further cost information for supervisees belowInclude cost for within service and outside service.

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Are you available to provide supervision under a reciprocal arrangement?

Yes

No

Experience

About mePlease describe your background in a paragraph or two, noting your designation and years of experience. This is the first information that people will read about you. You may wish to include what interests you, your values, languages spoken, diversity etc.

The text you enter in the above text box will show on your public listing.

My experienceMinimum 3 years in a designated mental health role is required. List here designated mental health roles you have held. This will assist supervisees to determine if you have had the experience that is relevant to them. This may include role title, organisation, clinical or non-clinical sector, any other important characteristics of the roles.

The text you enter in the above text box will show on your public listing.

My current role/workProvide details of your current position to support supervisees confidence in the relevance of your role to their work. This may also assist in determining any conflicts of interest if you are working for the same organisation.

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My trainingSpecify any relevant training you have engaged in.

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Do you supervise from an intersectional lens? If yes, please indicate relevant experience Your response below will show on your public listing. Select as many as apply.

First Nations

LGBTQI+

Culturally and Linguistically Diverse background

Family violence

Disability

AOD

How many years of discipline-specific practice do you have?

How many years have you been providing discipline-specific supervision?

My approach to supervisionDescribe in a short paragraph or two the approach you take towards supervision, your values as a supervisor, any methods or tools you use, why you are offering this service, what motivates you and what you aim to provide. Include any other information that will assist the supervisee to determine a suitable match.

The text you enter in the above text box will show on your public listing.

Availability and delivery

Do you have experience in providing group supervision?

Yes

No

What format of supervision do you provide? Your response above will show on your public listing.

Individual

Group

What frequency of supervision can you provide? Your response above will show on your public listing. Tick as many as apply.

Monthly

Fortnightly

Weekly

Mode of delivery Your response above will show on your public listing. Select all that you are able to provide.

Online

In person

Phone

In what geographical areas are you able to provide supervision in person?Please list a few suburbs or the general area/region you practice in.

The text you enter in the above text box will show on your public listing.

Further comments about your availabilityPlease state if you are able to attend other services for individual or group supervision.

This field is optional. The text you enter in the above text box will show on your public listing.

Consent

I consent for my public information to be made available in the supervisor database.

I confirm I have capacity to provide supervision.

I agree to receive supervisor database communications from VCCMHW

I would like to receive the VCCMHW newsletter and mental health sector communications

What are you looking for?

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Please fix the following errors:

Details

Experience

Availability and delivery

Consent