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CCCDW, LLC

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Counselor Supervision

Training Selection

Point of Contact Name

POC Email

POC Phone

Name of Requesting Organization

Date of Training

Number of Attendees (Approx)

Comments / Special Instructions

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Disclaimer: CCCDW, LLC is not a crisis center. Please report to the nearest emergency room or dial 911 immediately if you are in crisis emotionally or physically. If you have suicidal thoughts and live in the US, please dial 1-800-784-2433 for the National Suicide Prevention Lifeline.

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