Social Work Supervision | The Mental Haven

Supervision Form

Complete this form to apply for supervision with Ms. Dañel Whitehead, LICSW-S.

Please note that supervision for LMSWs is only non-clinical at this time.

First name

Last name

Phone

I understand that I will need to submit a current job description from the place of employment I am employed with a verification of authenticity from the agency director.

I know an understand the board's requirements regarding how many hours of supervision I will need to complete.

I understand that submitting this form does not guarantee Supervision. I understand I will meet with Ms. Dañel first and she will make a decision from there. I also understand that Supervision with Ms. Dañel costs $55 per hour and will need to be paid prior to each hour.

I understand Ms. Dañel only provides virtual supervision at this time.

What time of the day works best for you for your initial meeting (30-45 mins)?

Morning

Afternoon

Evening

Doesn't Matter

Supervision Form

Hours of Operation

Contact Us

Menu