Clinical Therapist Application
Please answer the following questions and upload a copy of your resume.
Name registered with the CSWMFT Board
*
First Name
Last Name
Name you go by
*
Pronouns
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email (we will be primarily communicating with you via email.)
*
example@example.com
License type
*
Please Select
LSW
LISW
LISW-S
SWT
LPC
LPCC
LPCC-S
CT
Other
If "Other," please specify.
*
If you only have a trainee license, please indicate when you anticipate receiving your dependent license (LSW, LPC, etc.)
*
Ohio License #:
*
Upload your cover letter below.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload your resume/CV below.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: