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Institute for Sexual Minority Health

Improving the health and well being of LGBT populations by raising awareness about homophobia, heterosexism, transphobia and the impact they have on us all.

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Individual Supervision Application

Step 1 of 2

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Contact Information
First Name*
Last Name*
Your pronouns
Email*
Organizations often enforce tight security on their network. Please enter a personal email address to ensure delivery of communication.
Phone*
Mailing Address
Address*
Street Address City State / Province / Region ZIP / Postal Code Country

Application details
Please answer the following questions in order to help me determine your objectives.
Populations served*
Please indicate one or more populations you serve.
- Couples & Families
- LGB
- Trans
- Youth
I have attended the 2 day clinical training focused on trans health offered by Françoise Susset*
- No
- Yes
I've attended another training focused on transgender health.*
- No
- Yes
Please list the professional Board(s) or association(s) to which you belong*
If you do not belong to any, please write "none"
Please indicate your most recent diploma*
- B.A.
- M.A.
- Ph.D.
- M.D.
I am a member of*
- CPATH
- WPATH
- Neither
Familiarity with WPATH Standards of Care (SoC 7th version)*
- I have never heard of it
- Somewhat familiar
- Very familiar
Your experience in assessing and supporting the needs of trans individuals*
- No experience
- Low (1-3 clients)
- Moderate (8-10 clients)
- High
Please provide at least 2 professional goals or objectives you have in regards to supervision*
Would you like to be notified of future trainings or supervision groups?
- Yes, please keep me informed
Comments
This field is for validation purposes and should be left unchanged.

Thank-you for your interest in individual supervision.
Please fill out this brief form and we will be in touch shortly.

If you experience any issues with this form or if you have additional questions please contact:
Françoise Susset: fsusset [at] ismh-isms [dot] com

Request a training

No two organizations are alike which is why we can customize any of our trainings for your specific requirements. Tell us all about your needs by filling out our request form.

Clinical Supervision

Individual and group clinical supervision can help expand your knowledge base and increase your confidence level in working with gender diverse individuals.

Consultation

Is your organization seeking to improve its welcome to gender diverse employees, clients, or students? We welcome the opportunity to offer our expertise in achieving your goals. Read more about our consultation services.

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