Non-Licensed Non-Certified Psychotherapist Public Disclosure

Please correct the errors described below.

All sections of this public disclosure must be completed, even if one puts not applicable. All pages need to be included as well.

Every document below is part of public disclosure and must be given to each client no later than the third office visit and must be submitted to this Office as part of your public disclosure.

Board of Allied Mental Health Practitioners.

Disclosure Document for Non-licensed and Non-certified Psychotherapists

First Name: Amelia

Middle Initial: P.

Last Name: Lincoln

Formal Education

Name of Institution: Northern Vermont University/Southern New Hampshire University

Dates Attended: August 2017 - August 2020

Degree(s) awarded if any: M.S. Clinical Mental Health Counseling

Name of Institution: New England College

Dates Attended: May 2008 - June 2009

Degree(s) awarded if any: M.S. Education


Title of Training Program: Upper Valley Educators Institute

Names & Addresses of trainer and/or institution: 194 Dartmouth College Highway Lebanon, NH 03766

Dates Attended: August 2006 - June 2007

Subject and/or content: Middle and High School Social Studies Education

Credential(s) awarded, if any: Teaching Certification

Title of Training Program: New England Institute of Addiction Summer School

Names & Addresses of trainer and/or institution: NEIAS PO Box 742, Augusta, ME 04332

Dates Attended: June 6-8th, 2015 and June 6-9, 2016

Subject and/or content: Substance Use Prevention Ethics, Anger Management for Youth, Motivational Interviewing

Credential(s) awarded, if any: N/A


Description of Practice: Student Assistance Professional, White River Valley School District Substance use prevention, supportive counseling, screening and referral for substance use and mental health concerns for middle and high school students.

Location: City/State/Zip: Royalton, Vermont 05068

Duration: November 2014 - Dec. 31, 2020

Status: Full-time

Receive supervision or peer consultation? Yes

How often? Weekly

Description of Practice: HALO Educational Systems - providing counseling, some with court-ordered clients with addiction issues and for those in Medically Assisted Treatment (MAT) for opiate addictions.

Location: City/State/Zip: 44 Roberts Road, Canaan, NH and 1 School Street, Lebanon, NH 03776

Duration: January 2020 - Present

Status: Part-time

Receive supervision or peer consultation? Yes

How often? Weekly

Description of Practice: Clara Martin Center, School-Based Clinician, Rochester School, counseling with students in K-12 at school and Recovery Staff at Safe Haven/Chris’ Place, a residential home and crisis bed unit for those recovering from acute mental illness and substance addictions

Location: City/State/Zip: Rochester, Vermont, and Randolph, Vermont 05060

Duration: Sept. 2014 - November 2015

Status: Part-time

Receive supervision or peer consultation? Yes

How often? Weekly

Scope of Practice

Therapeutic Operation: Person Centered, CBT

Area of Specialization: at-risk youth and those affected by developmental trauma

Treatment Methods: Cognitive Behavioral Therapy and Motivational Interviewing

My practice is also governed by the Rules of the Board of Allied Mental Health Practitioners. It is unprofessional conduct to violate those rules. A copy of the rules may be obtained from the Board or online.

Client’s Disclosure Confirmation

My signature acknowledges that I have been given the professional qualifications and experience of (Name, Name), a listing of actions that constitute unprofessional conduct according to Vermont statutes, and the method for making a consumer inquiry or filing a complaint with the Office of Professional Regulation. This information was given to me no later than my third office visit.

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