Title

This is your professional title (E.g. Rabbi, Cantor)

First Name *

Last Name *

Suffix

This would include RJE, Ph.D, Ed.D.

Pronouns *

Email *

Phone *

Are you an ARJE member? *

Enter required value Yes No I would like to join

Organization *

City *

Organization City

State/Province *

Job Title *

What do you hope to gain from participating in this program? *

What do you love about being a supervisor? What do you find challenging? *

List three supervisory strengths. *

What supervisory area would you be interested in learning more about? *

Attendance and Sessions *

My institution and I have agreed to prioritize my attendance at the scheduled sessions. Should an emergency arise, I will contact the group leader as soon as possible. Once logged on, I will be as present as possible.

Additional Information *

Would you like to share anything with the cohort leader to ensure that your experience is valuable or any accommodations you may require?

Supervisee Information *

Enter required value I have spoken to my supervisee about this program and they will be completing the application Please send the program nomination form to my supervisee and let them know they have been nominated.

Names of Supervisee *

Supervisee Email Address *

Supervisee Phone Number *