Council for Relationships | Intern and Unlicensed Staff Supervisory Preference Form

Please indicate your preferred time slots by selecting your 1st choice and 2nd choice. As you know, scheduling is an awesome task. We need as much flexibility as possible while trying to accommodate programmatic requirements and individual needs. Please respond to the following items and return to the Academic Administrator.

Name*

First Last

Email*

Preferred contact number

Preferred day(s) of the week and time(s). Please pick your 1st choice.*

Monday 12-3:00 pm
Tuesday 12-3:00 pm
Wednesday 12-3:00 pm
Thursday 12-1:00 pm
Friday 12-2:00 pm

Preferred day(s) of the week and time(s). Please pick your 2nd choice.*

Monday 12-3:00 pm
Tuesday 12-3:00 pm
Wednesday 12-3:00 pm
Thursday 12-1:00 pm
Friday 12-2:00 pm

Other preferred day(s) of the week and time(s) please specify.

Location requested-please pick your first choice.*

Location requested- please pick your second choice (if needed).*

Please specify if there is a satelite office that is closest to your home or work.

Supervisory issues that may impact your assignment:

Date

Search for a therapist, a psychiatrist or other content:

Intern and Unlicensed Staff Supervisory Preference Form