Nanas Assessment Form

Nana’s Needs Assessment
Supervision and CE Training to Further Your Career and Improve Your Skills

Making Your Practice Evidence Based

Directions: Please help us understand your needs related to professional supervision and CE Training. It is not required to place your name on this assessment unless you would like to participate in one free introductory supervisory session which will be scheduled on a Friday.

Name:

Email:

Phone:

1.A.Region:	Phoenix Scottsdale Mesa Tempe Gilbert Chandler Glendale Tucson Other:
B. Best Days for training:	Monday Tuesday Wednesday Thursday Friday Saturday Sunday
2. Do you need supervision to conduct your practice?	YES NO
Do you need CE to maintain your credential or license? YES NO
If no to both questions, please stop this assessment. You do not need to complete this survey. If yes, please continue.
3. Which of the following statements best describes your professional work role? Mark all that apply.
Counselor Social Worker Psychologist Play Therapist Nurse Psychiatrist Administrator Student Other
4. Which of the following ranges best describes a fair price to pay for high quality and required supervision and/or CE training?
A. Supervision dollars per hour:	85-95 75-85 65-75 55-65 45-55 35-45 Other:
B. CE training dollars per hour:	85-95 75-85 65-75 55-65 45-55 35-45 Other:

5. Please evaluate the statements below as they relate to your current involvement in obtaining supervision and CE training units.

I require individual supervision.
I would like online individual supervision.
I require group supervision.
I require intensive training in trauma resolution play therapy.
I require workshop training in trauma resolution play therapy.
I require intensive training in parent and family intervention play therapy.
I require workshop training in parent and family intervention play therapy.
I require CE training units to maintain my license or credential.
I want to get my CE training online.
I require a trainer to provide in-service training at my organization. Possible Dates:
My knowledge about Nana’s Children makes me feel confident that the supervision they provide will be high quality.
My knowledge about Nana’s Children makes me feel confident that the training they provide will be high quality.

6. If you could tell us one thing about getting supervision and/or CE units.
What would that be?

7. What workshop topics would you attend?

Making Your Practice Evidence Based