Vetting Counselors Form

Gender*

Male
Female
Others
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Race*

American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
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Sexual Orientation*

Straight
Gay
Lesbian
Bisexual
Trans
Others
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Are You Licensed? *

Not yet licensed
Half way licensed
Fully licensed
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Did you or an immediate family member serve in the military?*

Myself
Wife
Husband
Brother
Sister
Mother
Father
Grandparents
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What Branch of the Military Did You or Your Family Serve In?*

Air Force
Army
Coast Guard
Marine
Navy
Did Not Serve
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Did You See Combat?

Yes

No

Do you accept insurance?

Yes

No

Do you work probono?

Yes

No

Are you Bilingual (English and Spanish)?

Yes

A little bit

No

Will you do virtual counseling?

Yes

No

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