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About
Welcome to the Institute
What is Psychoanalysis?
Board of Directors
Staff/Contact Us
Careers
Annual Report
Schiele Clinic
About the Clinic
Pay for Clinic Services
Sign up for Clinic Services
Faculty
Faculty Directory
Candidates and Advanced Candidates
Education & Training
Analytic Training Programs
Training in Child and Adolescent Psychoanalysis
Training in Adult Psychoanalysis
Open Analytic Theory Classes
Advanced Psychodynamic Psychotherapy (APP) Program
APP Alumni Resources
APP Teacher of the Year
Practicums, Internships & Fellowships
Schiele Clinic Internship/Practicum Programs
Schiele Clinic Evaluation Practicum
Non-Profit Management Practicum
Schiele Clinic Post-Graduate Fellowship
Research Fellowship
Distance Learning
Scholarship Opportunities
Online Tuition & Fees
Lectures & Seminars
Current Lectures and Seminars
Working in the Wilds of Cyberspace:
Child Development Conference 2021
Zero to Six with Ed Sprunger, MSW, LCSW
In Pursuit of Psychic Change
The Psyche & The World Outside
Windows into the Therapy Process
Psychosomatic Disorders: A Historical Perspective
Psychoanalytic Perspectives on Climate Change
The Cohn Lecture 2021: Neuropsychoanalysis
Registration
Endowed Lectures
Continuing Education Credit Information
Distance Learning
Group Supervision
Resources
Calendar
The Betty Golde Smith Library
Library Resources for Students
Current Library Journals
New Acquisitions
APP Alumni Resources
Listen to our Podcasts
Watch Our Video Lectures
Read Our Psychoanalytic Perspectives
Giving & Support
Make a Donation or Tribute
Other Ways to Give
D.W. Winnicott Society
Professional Development
Professional Development
APP Application
Home
APP Application
APP Application
Application for admission to the Advanced Psychodynamic Psychotherapy program.
Please note: for all attachments requested for this application, please attach them in a separate e-mail to:
Margo Smith
. If you are returned to a blank form upon hitting "submit," this indicates your form did not go through for processing -- please contact Margo Smith at 314-361-7075 x 319 or e-mail
Margo Smith
.
I am applying for
*
Advanced Psychodynamic Psychotherapy Program (APP)
Date:
*
I. CONTACT INFORMATION
Last Name:
*
First Name:
*
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.
Mrs.
Ms.
Mx.
Other:
Home Address:
City, State, Zip:
Telephone:
*
Cell Phone
Email:
*
Enter Email
Confirm Email
Work:
Name of Institution:
Website:
City/State/Zip
Work Telephone:
Work E-mail:
Preferred communications:
Home
Work
Date of Birth:
Place of Birth:
Citizenship/Status:
II. ACADEMIC BACKGROUND
Name of Institution: Please add Dates, Location, Major and Degree
Additional Degree:
Additional Degree:
Special interests during your education:
III. EMPLOYMENT EXPERIENCE
Current Employment - Profession:
Place of Employment:
Position:
Length of Employment:
Description of what you do:
Previous Employment: Dates, Position and Experience
Additional Previous Employment: Dates, Position and Experience
Supervision, Consultation, Practicum or Volunteer Experience (that is relevant to this application):
IV. OTHER INFORMATION (If Applicable)
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:
V. REFERENCES
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 answer the following questions and e-mail your answers to
Margo Smith
, Director of Recruitment and Alumni Affairs. We ask that you limit your responses to a total of three typed pages in size 12pt type.
All Applicants:
1. What are your goals in undertaking this program?
2. Briefly describe an incident in your work in which you were pleased with your efforts.
3. Briefly describe an incident in your current work in which you feel you did not do as well as you would have liked. What additional information or guidance would have helped you?
4. How would this program fit in with your professional objectives/plans over the next five years?
5. Describe your experience doing psychotherapy or counseling.
VII. ADMINISTRATIVE INFORMATION
How did you hear about or find this program?
A. Do you intend to use this program for degree credit at an academic institution? Yes/No If yes, please describe your arrangement.
B. Do you anticipate needing to use video conferencing to attend classes/supervision?
*
Yes
No
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
Do you wish to apply for financial aid?
*
Yes
No
Please explain:
For Scholarship Consideration
*
Select All
I am submitting my course application along with a completed scholarship application to be considered for scholarships.
I will be mailing a copy of my tax return and financial need statement to: Randi Sarsfield, St. Louis Psychoanalytic Institute, 7700 Clayton Rd, Ste 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.
CLICK HERE FOR NEED-BASED SCHOLARSHIP APPLICATION
CLICK HERE FOR MERIT SCHOLARSHIP APPLICATION
VIII. SUBMISSION AGREEMENT
Terms of agreement - 1
*
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.
- 2
*
I also understand that this program is not being represented as training for practice in Psychoanalysis but as augmentation of existing theoretical knowledge and clinical skills in advanced psychoanalytically-oriented psychotherapy, for which specific recognition will be given upon graduation.
SIGNATURE _______________________________________________________________________ DATE__________________________________
There is a $75 application fee due at the time you submit your written application.
The application fee covers the processing of your application along with your applicant interview which will be scheduled for you in the near future.
Completed applications may be mailed with your application fee to:
Margo Smith, St. Louis Psychoanalytic Institute, 8820 Ladue Road, 3rd floor, St. Louis, MO 63124.
Please enclose a check payable to the St. Louis Psychoanalytic Institute.
Please indicate your form of payment below:
*
I will mail in my payment.
I am processing an on-line payment.
Reminder:
For your application to be considered for financial aid, your completed application form, tax return, brief statement of financial need and references must be received by April 15th. Applications received later than April 15th will be considered by the Financial Aid Committee only if funds are available.
Application Fee. Note that the Tuition price is for ONE YEAR of the TWO-YEAR program. Tuition will be billed twice a year.
Price:
$75.00
Quantity:
Total
$0.00
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