Thank you for your interest in joining the COAC team! Please complete the following form, including a PDF of your updated CV, to apply as a therapist.
Name
First Name
Last Name
Email
example@example.com
Please select your primary area of treatment focus/interest as a therapist.
Please Select
Depression/Mood Disorders
Anxiety and OCD-related Disorders
Generalist
Substance use/Addiction
Delusional/Psychotic Disorders
ADHD
PTSD/Trauma-related Disorders
Couples Counseling
Eating Disorders
Anger Management
Other
Please select the option that best describes your licensure status in Ohio.
I am actively and independently licensed as a psychotherapist in Ohio.
I am in the process of obtaining my independent license as a psychotherapist in Ohio.
I am not independently licensed as a psychotherapist in Ohio, but plan to do so in the next several years.
I am not independently licensed as a psychotherapist in Ohio, and have no plans to do so.
Which range best matches your desired number of client hours per week?
Less than 10 hours
11-15 hours
16-20 hours
20+ hours
Please indicate any and all age ranges of the client populations with which you work (select all that apply)
Children (under 12)
Adolescents (13-17)
Adults (18-64)
Older Adults (65+)
How much of your prior training or educational background focused on the treatment of anxiety and OCD-related disorders?
25% or less
26-50%
51-75%
More than 75%
In your current or most recent role, approximately what percentage of your caseload focused on primarily treating anxiety or OCD-related disorders?
less than 25%
25-49%
50-74%
more than 75%
In your next role, approximately what percentage of your caseload would you like to be focused on anxiety and or OCD-related disorders?
less than 25%
25-49%
50-74%
more than 75%
Please rate the following related to the treatment of anxiety and OCD-related disorders, overall.
Not at all
Slightly
Moderately
Considerably
Significantly
Experience
Training/Education
Confidence
Effectiveness
Interest
Please select the therapeutic modality that most closely matches your approach.
Psychodynamic Therapy
Cognitive-Behavioral Therapy
Humanistic/Person-Centered Therapy
Third-Wave Therapies (DBT, ACT, MBCT, MBSR, etc.)
Behavioral Therapy
Other
Are you comfortable with and experienced in providing telehealth services?
Yes, I am both comfortable and experienced
I am comfortable but lack experience
I am experienced but not comfortable (or I prefer in-person)
No, I am neither comfortable nor experienced
Have you ever been subject to disciplinary measures by a professional regulatory board, experienced revocation or suspension of your professional license, or been the subject of a formal complaint in relation to your practice as a psychotherapist?
No
Yes
Please explain your "yes" response further
Please explain your views regarding evidence-based practices.
Please explain your interest and motivation for applying to COAC.
Please upload a copy of your CV in PDF format.
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I certify that all of the above information, including that in my attached CV, is accurate to the best of my knowledge.
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