Information Request
Thank you for your interest in Dr. Brandynicole, LLC! Dr. Brandynicole will use the skills of engagement, empowerment and education to get your audience excited about the work ahead. Please complete this booking request form and a member of her team will be in touch within 24-72 business hours.
Your Information
Name
First Name
Last Name
Email
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Preferred Method of Contact
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Email
Phone (Text)
Phone (Call)
Request Type
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Consultation
Learning & Development
Clinical Supervision
Copy/Content Editing
Speaking Engagement
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1:1 Consultation
Have you participated in 1:1 Consultation in the past?
Yes
No
If yes, please share what worked well for you and what did not.
What challenge do you hope to address with consultation?
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Learning & Development
Organization Name
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Type of Organization
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Nonprofit Organization
College/University
Small Business
Child Welfare Agency
Mental Health Agency
Other
If other, please describe.
What training topic do you have in mind?
What challenge do you wish to address with this challenge?
What type of training do you feel would be best?
Training of Trainers
Participant Training
How many participants are you expecting in the training?
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Clinical Supervision
Where are you currently applying for licensure?
Please Select
District of Columbia
Virginia
Other
What is your highest degree?
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BSW
MSW
Other
What is your current area of specialization?
Which type of clinical supervision are you seeking?
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1:1
Group
Both
How many hours of clinical supervision do you currently have?
What do you hope to get out of clinical supervision?
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Copy/Content Editing
Copy and content editing includes formatting utilizing APA format. The final cost for editing is based on the complexity of the edits. You will receive a quote for editing prior to work beginning. All documents uploaded to this form are held in strict confidence and will not be shared with any entity. If you'd prefer to email the document, please click the box below and we will be in touch.
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Select this box if you'd prefer to email your document. (Email to brandynicole.brooks@gmail.com).
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Submission
Thank you again for your interest in working with Dr. Brandynicole, LLC. As stated, we will be in touch within 24-72 business hours.
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