Diploma in GSRD Therapy Supervisor Endorsement

Applicant Name *

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Last

Supervisor's Name *

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Last

Your Email *

Address *

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Address Line 2

City

State / Province / Region

Postal Code

Country

How long have you supervised the applicant's work? *

What are the applicant's strengths in working with GSRD clients? *

Please state areas for development that have been identified in the applicant's work with GSRD clients. *

Please comment briefly on the applicant's ability to manage boundary issues arising from dual relationships. *

Can you let us know what if any specific training in the supervision of GSRD therapy you have personally *

Declaration (please enter your name below). The information on this form is to the best of my knowledge true and correct. *

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