Provider Application Form

Manhattan Alternative is a nationwide listing site and community for providers who identify within at least one of the following umbrellas: LGBQIA+, trans/GNC, kink/BDSM, poly/CNM, and those with a history of adult industry work. Please note: While we are now accepting applications from providers who identify within at least one of the communities just mentioned, we will continue to prioritize BIPOC/PGM providers with one or more of those identities, as well as others who have multiple intersecting personal connections to our communities of focus. Please read ManhattanAlternative.com/Privacy-Protocol to learn about steps taken to ensure your information is kept private.

Listing priority is also given to those who are referred by an existing ManhattanAlternative.com provider that they know personally, and listing publication is not guaranteed. Please also note that when reviewing listing submissions, we take into account the written content of the listing submission, as well as evidence of shared values in language used on other websites (e.g., direct website, Psychology Today profile, social media, etc). This means that timing for screening and publishing new listings can vary widely, from the same day to several weeks or longer. We try to respond to every inquiry and follow up email but we may not always be able to; please don’t take it personally. Please read our Community Guidelines to see if you feel like you’re a good fit and can comply.

This is for new listings only; to update a current listing, go to ManhattanAlternative.com/Listing-Update-Form.

"*" indicates required fields

Step 1 of 7

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This field is for validation purposes and should be left unchanged.

Name (as you would like it to appear on the site)*

Pronouns (if you would like them included on the site)

Honorific (if you would like it included on the site):

Degrees/Licenses/Certifications (must be directly associated with/in support of the profession you are listing)*

If your license requires that you practice under supervision (e.g., LMSW), please indicate the name and email address of your supervisor for confirmation (I will send a brief email to confirm):

Title (this will appear under your name on the main page; e.g., psychotherapist, psychologist, psychiatrist, etc)*

Subtitle/Specialization (this will appear under your title on the main page; usually keywords indicating your areas of focus, specific populations, treatment approaches, etc; see other profiles on the main page for examples)—please note that this line has a maximum of about 24 characters including spaces*

Website (must be to your web or profile page, not a general practice page (unless you're the only person at the practice))*

Email (messages must go directly to you, rather than admin staff at a general practice (unless you're the only person at the practice))*

Phone (must be a direct phone number, not a general practice phone number; if you'd rather not list your phone number on your profile, please include something else for this field in order to fit the template, such as another page on your website, a different website, or a social media handle)*

Facebook Page (optional)

LinkedIn Profile URL (optional)

Instagram Handle (optional)

Please include a 100 (minimum) to 125 (maximum) word bio for your individual profile page.*

Upload Photo: Must be a minimum of 640×640 dpi, and maximum 64 MB file size. It's fine to submit photos larger than 640×640 (and up to 64 MB); they will be cropped and downsized to fit. Please do not submit photos with original dimensions smaller than 640×640, as they may be blurry/too pixelated.*

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 100 MB.

How did you hear about ManhattanAlternative.com?*

Please provide one or two reference(s) that can speak to your community involvement and professional practice—one reference is sufficient if they are a provider already listed on Manhattan Alternative, but please provide two references if they are not listed on Manhattan Alternative. References must be from outside of your practice, and must not be your supervisor. (Please note: We will send a brief email to confirm they know you, with all identity information removed per the privacy protocol; listing priority is given to those who are referred by someone already on the site.)*

*Listing priority is given to those who personally hold multiple identities within the communities we serve. Please indicate whether you are or have been personally affiliated with any of the following identities/communities/practices (this information is used for screening purposes only, is kept private, and will be permanently deleted after the screening process):

BDSM/Kink

CNM/Poly

LGBQIA+

GNC/Trans

Current/Former Sex Worker

How has your personal experience impacted your kink/poly/trans/LGBQ clinical competence?*

If you identify as an ally to one or more of these communities, how do you practice being kink/poly/trans/LGBQ-affirmative and -competent?*

Do you lack clinical competency in any areas related to non-mainstream (i.e., kink, poly, CNM, LGBQ, trans, GNC, etc) identifications, communities, and/or practices? If so, what are they, and how are you working toward improvement in those areas?*

Please describe your reason(s) for wanting to work with kink/poly/trans/LGBQ-identified individuals.*

Please describe any work you have done directly with LGBTQ-identified, kink-identified, and/or poly-identified people and communities.*

Please list any publications you’ve authored/co-authored relating to these populations.

Please list any conference presentations or facilitation of clinical seminars relating to these populations.

The Manhattan Alternative Providers listserv is for giving and receiving referrals and sharing community resources. If you would like to be added to the listserv, please enter the email address you'd like to be visible to the community when you post or reply. (If you have GMail, you will have more control over your frequency preferences; if not you can just ask us to adjust your frequency preferences.) If you don't want to be on the listserv, please enter N/A.*