Registration – Supervision and Leadership 6.5.1

Name*

First Last

Credentials*

Agency/Organization*

Current Position*

Address*

City State ZIP Code

Mobile Phone Number*

(NFARtec Staff & Consultants will be sending weekly SMS text messages related to course content (learning extenders). By inputting your phone number, you consent to receive text messages through an automatic telephone dialing system.)

Email*

Enter Email Confirm Email

Password*

Enter Password Confirm Password

Strength indicator

How many years of experience do you have providing clinical supervision?*

Please enter a number from 0 to 99.

Are you currently providing clinical supervision in a behavioral health setting?

Yes
No

What do you hope to learn by participating in this online learning series?*

By checking here you are indicating that you understand the pre-requisite and technology requirements as well as the time commitment to participate in this training.*

I understand the time commitment involved and agree to fully participate.