MAP Agency Supervisor Training Application

Application to be selected for
MAP Agency Supervisor training
2-day direct service workshop

Note: Please scroll down after the introduction to begin filling out the application.

The mission of the South Carolina Center of Excellence in Evidence-Based Intervention (the Center) is to support agencies and organizations in the selection and implementation of evidence-based interventions to promote youth and family well-being and to address challenges related to behavioral health problems and substance use. Our vision is to make evidence-based support and intervention available when and where youth and families need them, promote excellence and accountability in service provision, and encourage a ready workforce through education and support efforts.

As part of its mission and vision, the Center of Excellence is providing resources to support a Managing and Adapting Practice (MAP) Agency Supervisor Training Workshop for 12 participants on September 13 and 14, 2018 in Columbia, SC. As a first step to be considered for a training seat, please complete this application. Participants will be selected by the Center and will be notified no later then September 4, 2018.

PLEASE NOTE: This application does not guarantee a seat in the training.

After you complete this application, your supervisor will be contacted by the Center to confirm her/his support for the application.

Training to become a MAP Agency Supervisor

The MAP Agency Supervisor Training is performed on 2 consecutive days for a cohort of 12 individuals, all of whom have completed the MAP Therapist Credential. After the workshop, participants will be divided into up to 6 individuals to participate in 6 consultation calls over a 6-month period to support application of MAP with at least two cases. Participants submit a MAP Agency Supervisor Portfolio for review by PracticeWise as the last step in becoming a MAP Agency Supervisor.

Upon completion of this application you will be emailed further information regarding where the training will take place. Additionally, an MOU will be emailed to you that will require your and your supervisor signatures.

Last Name(required)

First Name(required)

Email(required)

Work Address(required)

Work Phone(required)

Cell Phone(required)

I understand involvement of the MAP training workshop and that this application does not guarantee a training seat.(required)

Yes

Other(required)

What field is your degree in?(required)

Current Profession(required)

How long have you worked in the child, youth and family field?(required)

Name of organization you work for(required)

Organization address(required)

Organization phone number(required)

How long have your worked for this organization?(required)

Current work position(required)

County or counties you work in(required)

Name of current supervisor(required)

Email address of current supervisor(required)

Phone number of current supervisor(required)

I understand that my supervisor will be contacted by the Center to confirm her/his support for this application.(required)

Yes

Additional Information

Please answer the following questions:

Application to be selected for MAP Agency Supervisor training 2-day direct service workshop

Training to become a MAP Agency Supervisor

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Application to be selected for
MAP Agency Supervisor training
2-day direct service workshop