Name *

First Name

Last Name

Phone *

(###)

###

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I am a licensed: *

*Licensed professionals who reside outside of Oklahoma and those that are candidates, volunteers, or are in need of an internship will not be considered.

Professional Counselor

Marriage and Family Counselor

Clinical Social Worker

Psychologist

Please read and confirm the following details: *

I understand this is a part-time, contract-based opportunity to serve seniors and their family members (as needed).

I understand that this opportunity involves providing services to clients in-person or via telehealth who are located within the community setting, such as at assisted living facilities that are located within my desired vicinity.

I am willing to abide by the policies dictated by ODMHSAS certification, such as training requirements.

I am willing to increase my skills and abilities to serve the unique needs of the senior demographic.