CCPDP

CCCC Clinical & Community Professional Development Program Application

The CCPDP aims to support the growth of new and early career clinicians from the disciplines of social work, professional counseling, and marriage & family therapy. The program seeks to ensure that clinicians are trained equitably, have a focus on the community, and are able to provide high-quality care to all clients. Individuals interested in gaining invaluable training and supervision as they work toward independent licensure are encouraged to apply. The program requires a graduate degree and the ability to practice at the generalist level under the supervision of a qualified professional.

If you are interested in the program, please complete this form in its entirety and upload additional required documents listed below. Applications are now being accepted.

Application form
List and/or statement of specific supervision requirements to achieve licensure based on license type, jurisdiction, and past professional experience
Professional resume
De-identified case presentation, client summary, intake or assessment (can be from school, past employment and/or fictional)
2 professional recommendations
Proof of degree and/or transcript
Proof of licensure (if applicable)

All applications submitted will be reviewed by the CCPDP Supervisory & Interview Committee. You will be contacted via email for an interview. Incomplete applications will not be processed.

Email *

Full Legal Name *

Preferred Pronouns *
She/Her
He/Him
They/Them
Other

If Other, what?

Phone Number *

Mail Address *

Licensure/Discipline (select all that apply) *
Social Work
Professional Counseling
Marriage & Family Therapy

Years of Post-Graduate Clinical Experience *
Less than 1
1-3
3-5
5+

If you do have past professional or clinical experience, please provide a brief description here:

If you do not already have your generalist level license, please indicate your anticipated date of licensure (a generalist level license or equivalent is required for the program)

Why are you interested in applying for the Clinical & Community Professional Development Program? *

How did you hear about the Clinical & Community Professional Development Program? *
School/College/University
Alumni Network or Newsletter
Social Media
Email
Website
Colleague
Other

If other, how?