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About
Welcome to the Institute
What is Psychoanalysis?
Board of Directors
Join our Mailing List
Staff/Contact Us
Annual Report
Schiele Clinic
About the Clinic
$ Pay for Clinic Services
Sign up for Clinic Services
Community Ed.
Community Education Speaker Form
Community Education Brochure 2024-25
Lectures and Seminars
Endowed Lectures
Continuing Education Credit Information
Distance Learning
Faculty
Professional Development
Faculty Directory
The K. Lynne Moritz, MD, Leadership Award
$ Pay Faculty Dues
Education & Training
$ Pay for Tuition
Analytic Training Programs
Training in Child and Adolescent Psychoanalysis
Training in Adult Psychoanalysis
Candidates and Advanced Candidates
Open Analytic Theory Classes
Child Adolescent/Adult Psychodynamic Psychotherapy Program
Child Adolescent Committee Courses
APP Alumni Resources
CA/APP & APP Teacher of the Year
CA/APP Students
Practicums, Internships & Fellowships
Schiele Clinic Training Programs
Almost Home Psychotherapy Program
Clinic Training Interest Form
Research Fellowship
More Information Interest Form
Distance Learning
Scholarship Opportunities
Group Supervision
Resources
Calendar
The Betty Golde Smith Library
Library Resources for Students
Articles & Podcasts
Watch Our Video Lectures
Read Our Psychoanalytic Perspectives
Giving & Support
Make a Donation or Tribute
Other Ways to Give
D.W. Winnicott Society
Analytic Training Application
Home
Analytic Training Application
If you are returned to a blank form upon hitting "next," this indicates your form did not go through for processing -- please contact Randi Sarsfield at 314-361-7075 x 322 or email
Randi Sarsfield
.
I am applying for:
*
Training in Adult Psychoanalysis
Training inChild and Adolescent Psychoanalysis - Traditional
Training in Child and Adolescent Psychoanalysis - Accelerated
I wish to be considered as a:
*
Full Clinical Candidate
Part-time Clinical Candidate
Academic Scholar
Date
MM slash DD slash YYYY
I. CONTACT INFORMATION
Name
*
First
Last
Middle
Degree
Preferred Name
How do you prefer to be addressed? Please indicate the title we should use in our formal correspondence with you:
*
Dr.
Mr.
Ms.
Mx.
Other:
Address
*
Street Address
Address Line 2
City
State / Province / Region
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Afghanistan
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Mali
Malta
Marshall Islands
Martinique
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Mayotte
Mexico
Micronesia
Moldova
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Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
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New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
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Panama
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Portugal
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Rwanda
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Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
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Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
Cell Phone:
Telephone:
Email:
*
Enter Email
Confirm Email
Work:
Name of Institution:
Website
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
Telephone:
Email:
Preferred communications:
Home
Work
Date and Place of Birth:
Date
MM slash DD slash YYYY
Place:
Citizenship/Status:
II. ACADEMIC BACKGOUND
(Scholar in Psychoanalysis applicants need only answer questions II.A and II.E in this section.)
Undergraduate and Graduate
A. Dates / Name of Institution / Location /Degree
Practicums, Internships and/or Residency:
B. Dates / Name of Institution / Responsibilities
Post Graduate Training:
C. Dates / Name of Institution / Description
Specialty Board Certification:
D. Dates / Board
Research Projects:
E. Project / Director / Address for Project Director
III. EMPLOYMENT EXPERIENCE
(Scholar in Psychoanalysis applicants need only answer questions III. A. and III. B in this section.) A. Current Employment:
Profession:
Place of Employment:
Position:
Length of Employment:
Description of what you do:
B. Previous Employment:
Dates / Position & Experience
C. Supervision, Consultation, Practicum or Volunteer Experience (that is relevant to this application):
Dates / Name of Institution / Responsibilities
IV. OTHER INFORMATION (If Applicable)
(Scholar in Psychoanalysis applicants need only answer question IV. A in this section.) A. Awards, honors, publications or other demonstrations of merit (list):
Dates / Description
B. Personal therapy or Analysis: (The Institute totally respects the confidentiality of the therapist/patient relationship and will not in any way attempt to contact the therapist.)
Name of therapist
Frequency of Sessions
Dates From To
Name of therapist
Frequency of Sessions
Dates From To
V. REFERENCES
(All applicants)
Please list two or more references. Your submission of this application form indicates that you give your permission for us to contact the names below.
Reference #1 Name / Address / Telephone / E-mail
Reference #2 Name / Address / Telephone / E-mail
Reference #3 Name / Address / Telephone / E-mail
VI. ADDITIONAL QUESTIONS
Please e-mail to
Randi Sarsfield
, Program & Services Coordinator, at office@stlpi.org your answers to the following questions.
A. For full and part time clinical candidate applicants in Child or Adult Program:
1. What are your goals in undertaking this program?
2. How would this program fit in with your professional objectives/plans over the next five years?
3. Autobiography: Please enclose a personal and professional history (not to exceed ten pages double spaced) describing the evolution of your interest in psychoanalysis.
B. For Child and Adolescent full and part time clinical candidate applicants:
1. Please describe your experience with children/adolescents.
C. For Scholar in Psychoanalysis applicants:
1. Please enclose a description of your academic/research interests and how you plan to use psychoanalysis in them. (A maximum of five pages double spaced, please).
VII. ADMINISTRATIVE INFORMATION
(All applicants are to complete this section.)
How did you hear about or find this program?
A. Other Psychoanalytic training applications: If you have applied for psychoanalytic training elsewhere, please list the Institute(s), date(s), and outcome(s):
May we contact these Institutes?
Yes
No
B. Do you anticipate needing to use video conferencing to attend classes/supervision?
Yes
No
If yes to needing videoconferencing, please explain why.
C. Describe any special circumstances (financial concerns, scheduling or personal issues) that may affect or complicate your participation in this program:
Will a third party be paying any or all of your tuition?
Yes
No
Please explain:
D. Do you wish to apply for financial aid?
Yes
No
For Scholarship Consideration
I am submitting my course application along with a request to be considered for a need-based scholarship.
I will be mailing a copy of my tax return, completed scholarship application, and financial need statement to: Randi Sarsfield, St. Louis Psychoanalytic Institute, 7700 Clayton Road, Suite 200, St. Louis, MO 63117, or drop them off at our offices.
I understand that if I apply for financial aid, my application, tax return, statement of financial need and references will be assessed by the Financial Aid Committee.
Completed scholarship applications are due before April 15th. To be considered "complete" the office must receive your application form (either electronically or by mail), and a hard copy of your current tax return, along with a brief statement of your financial need.
CLICK HERE FOR NEED BASED SCHOLARSHIP APPLICATION
CLICK HERE FOR MERIT SCHOLARSHIP APPLICATION
VIII. SUBMISSION AGREEMENT
(All applicants are to complete this section.)
For All Programs:
I understand that my application and progress within this program will be subject to assessment by the instructors in the program and agree to abide by this assessment.
I have requested a transcript be sent to the St. Louis Psychoanalytic Institute from
A transcript will be sent from:
SIGNATURE
DATE
There is a $300 application fee due at the time you submit your written application.
The application fee covers the processing of your application along with your applicant interviews which will be scheduled for you in the future.
Completed applications may be printed and mailed with your application fee to:
Randi Sarsfield, St. Louis Psychoanalytic Institute, 7700 Clayton Road, Suite 200, St. Louis, MO 63117 or completed and submitted online.
The application fee may be submitted by check (payable to the St. Louis Psychoanalytic Institute) or submitted online.
Please indicate your form of payment:
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