Britt-Marie Scholarship for Analytic Candidates

This scholarship fund was created by Lynda Fields to benefit the continuing education of new or existing Analytic Candidates. The funds of this scholarship are distributed to the selected candidate(s) and require the candidate to sign this document stating that the candidate ensures the funds will be used solely for STLPI tuition, the costs of their personal analysis, or other expenses related to completing Analytic coursework (e.g. books, attending conferences or community education lectures, etc). Failure to complete the requirements of the scholarship by the stated deadline may require the candidate(s) to return all or a portion of the funds.

Name

First Last

Training Year

Email Address

Phone Number

Employer Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Required Documentation Listed Below

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Please note that omission of the following may result in your application being rejected for insufficient information by the Scholarship committee. 1) A narrative, of no more than one 8 ½ x 11 page, outlining your current financial situation and explaining why you should be considered for this scholarship. 2) Your most recent tax return. If married, you must submit your full tax return, including your spouse’s tax return.

Disclaimer

I understand

By signing this document and submitting this application, I understand that if awarded this scholarship I will be required to supply proof to the scholarship committee, in the form of receipts, that the funds awarded were used for STLPI tuition costs, the costs of my personal analysis (omitting all personal information to maintain anonymity) and receipts for any other educational costs incurred to pursue Analytic Training at STLPI. The receipts must be submitted within eight months of receiving the scholarship funds. I understand that if the funds are not used for one of the above outlined items, or I fail to submit the receipts by the deadline, I may be required to return a portion or all of the funds. Please note that the scholarship selection committee consists of Institute Board members and members of the Budget and Finance Committee of the Saint Louis Psychoanalytic Institute. Funding for the scholarship program is provided by donations from individuals, corporations, and foundations. Due to the limited pool of resources and the volume of applicants, the scholarship committee does not provide scholarships in which the applicant is requesting 100% of their educational costs at STLPI. Additionally, the scholarship committee will not consider your application without a tax return and a letter explaining your financial circumstances. Failure to submit that documentation will likely result in your application being denied. Institute Faculty have zero input into the selection process. All application information is highly confidential. For further information about the scholarship application process, please contact Randi Sarsfield, Registrar/Programs Manager, at r.sarsfield@stlpi.org. Changes: "St Louis Psychoanalytic Institute" → "Saint Louis Psychoanalytic Institute" "committee" → "Committee" (Budget and Finance Committee) "process please contact Pamela Luttrell at office@stlpi.org" → "process, please contact Randi Sarsfield, Registrar/Programs Manager, at r.sarsfield@stlpi.org"

Digital Signature (Write your name)

Date