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Society & System · SF-003 · Trace

Application for Licensure

What if bearing witness at a significant moment required a licensed professional?

· · · ·
Licensed Witness Registry · Form LWR-7 (Application for Initial Certification) · Section D, Question 12 is unanswered.

Licensed Witness Registry
Application for Initial Certification, Form LWR-7
Section A · Applicant Information
Full name: Torel M. [surname redacted]
Date of application: 09 / 14 / [year redacted]
Current occupation: Administrative coordinator, retired
Years in current occupation: 22
Section B · Professional Qualifications
B-1. Do you have prior experience attending to others in a professional or caregiving capacity?
Yes. Fifteen years as primary administrator for a hospice organization. Previous to that, volunteer work in a hospital setting.
B-2. Describe your understanding of the licensed witness's role and its limits.
The witness is present. The witness does not intervene, advise, comfort, or interpret. The witness documents nothing beyond the fact of attendance. The witness is not a participant. The witness is present.
Section C · Declaration of Capacity
C-1. Can you maintain confidentiality regarding the specific content of witnessed events?
Yes.
C-2. Can you refrain from comment, counsel, or emotional response during an assignment?
I have been asked this question before in other forms. The answer is yes.
C-3. Are you willing to witness events that may cause you personal distress?
Yes. I understand this is the work.
Section D · Personal Statement
D-12. In your own words, describe why you are seeking licensure as a witness.
 
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