Full legal name *

Preferred name

Email *

Preferred Contact Method

Phone

Text

College or university

Graduate counseling program

Degree being pursued

Concentration, if applicable

Expected graduation date

Is your program CACREP accredited?

Yes

Unsure

Do you currently hold an active Virginia Resident in Counseling license? *

Yes

Are you currently providing residency services through another practice or worksite? *

Yes

Do you currently have another Virginia Board approved supervisor?

Yes

Resume or CV *

Unofficial Transcript *

Cover Letter

Click to upload

Relevant professional certifications

Click to upload

Other relevant professional documentation

Click to upload

I certify that the information provided in this application is accurate to the best of my knowledge.

I acknowledge

I understand that I must hold an active Virginia Resident in Counseling license before applying and that CVMHS does not sponsor initial Resident in Counseling license applications.

I acknowledge

I understand that the CVMHS Clinical Residency Program is an employment based program and is not a supervision only program.

I acknowledge

I understand that supervision provided through CVMHS applies only to clinical services I perform through CVMHS.

I acknowledge

I understand that CVMHS and Dr. Sophia Sills Tailor do not supervise or verify residency hours I earn through another practice or worksite.

I acknowledge

I understand that CVMHS residents must maintain a flexible schedule that includes daytime availability and scheduling in blocks of at least four consecutive hours.

I acknowledge

I understand that submitting this application does not guarantee employment, residency placement, or supervision through CVMHS or Dr. Sophia Sills Tailor.

I acknowledge

I understand that supervisory agreements and applicable residency paperwork will be completed only after I have been interviewed, selected, received a conditional employment offer from CVMHS, and accepted that offer.

I acknowledge

Electronic signature *

Clear

Date *

CVMHS residents must maintain a flexible schedule that includes daytime availability and must be available to work in blocks of at least four consecutive hours.