SOUND Life Recovery - Individual Supervision

Individual Supervision - Waitlist

Prerequisites: 1) WA State associate level licensed professional, 2) professional liability insurance - minimum 1mil/3mil with Jeffery J. Roskelley, LICSW & SOUND Life Recovery, PLLC added as additional insured, 3) primary supervisor in place IF SLR supervisor is acting as a secondary supervisor (not necessary if SLR is acting as primary)
Welcome WA State Associates!

We'll contact you when a seat opens in our 1:1 supervision program. At that point, you will have 5 calendar days to fill out an application before we offer the spot to the next applicant. You are welcome to begin completing your application now, saving it as you go. Clinicians interested on being on our waitlist must complete this waitlist form, regardless of initiating a full application.
Name, as it appears on professional license*

First NameLast Name
Preferred name
If different from name on license
Cell Phone Number*

Area CodePhone Number
Your Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What associates license do you hold?*

LMHCALSWALMFTASUDPOther
Please use your mouse or trackpad to write your signature below.
By providing your e-signature below, and submitting this form, you: 1) are adding your name to a waitlist for approved supervision with SOUND Life Recovery, and 2) agree to communicate via electronic means.

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Individual Supervision - Waitlist