Become a Volunteer Clinician

Thank you for volunteering your professional services to the Pro Bono Counseling Project.

Please complete this form and send a copy of your liability insurance to us by fax, email or mail.

Fields marked * are required

During the next 12 months I can commit to:
About you:
If student or graduate-level license
Contact information:
Therapy Address:
Mailing Address:

Please provide two or more names, including email address and phone number, of licensed clinicians, including LG's who may be interested in joining the Pro Bono Counseling Project

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