Diploma in GSRD Therapy Supervisor Endorsement

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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

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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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