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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
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
Child Adolescent/Adult Psychodynamic Psychotherapy Program
APP Alumni Resources
APP Teacher of the Year
Practicums, Internships & Fellowships
Schiele Clinic Internship/Practicum Programs
Clinic Training Interest Form
Schiele Clinic Post-Graduate Fellowship
Research Fellowship
More Information Interest Form
Distance Learning
Scholarship Opportunities
Online Tuition & Fees
Group Supervision
Professional Development
Lectures & Seminars
OTSL Docent Presentation on Awakenings
Community Education Speaker Form
Endowed Lectures
Continuing Education Credit Information
Distance Learning
Resources
Calendar
The Betty Golde Smith Library
Library Resources for Students
Current Library Journals
New Acquisitions
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
Clinic Training Interest Form
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Clinic Training Interest Form
Clinic Training Interest Form
This form is 1 of 3 steps you must complete for your application to be processed for the Schiele Clinic Training Program.
Step
1
of
4
25%
Please review the Clinic Training Info Sheet thoroughly before submitting the Interest Form. If your Interest Form is selected for a screening (step 2 in the application process), you will receive a response from maryanneboston@stlpi.org within 2 weeks to schedule your screening.
Clinical trainees who have a record are encouraged to notify the Clinic Team of this information in writing (see instructions below for Special Circumstances) as part of their application to the Clinic Training Program. Potential clinical trainees with a record will be evaluated on a case-by-case basis by Institute leadership to determine whether a relationship with the Schiele Clinic is appropriate.
Please Check Each Box Below
I understand that this program is a 12-month commitment.
I agree to complete a comprehensive background check prior to scheduling a screening with the Clinic.
I understand the Time Requirements presented on the Clinic Training Info Sheet and agree to them.
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Are you currently located in St. Louis area?
Yes
No
Are you willing to relocate to St. Louis area?
Yes
No
Are you currently pursuing professional licensure?
Yes
No
Are you currently in personal therapy or analysis?
Yes
No
How often do you meet with your therapist or analyst?
Are you interested in pursuing a professional license postgrad?
Yes
No
Language Fluency
Please list any languages you are fluent in
Are you interested in providing therapy in this language at the Schiele Clinic?
Please answer if you have listed a second language
If YES, do you have experience providing services in this language?
Please answer If you have listed a second language
Are you interested in providing psychotherapy to children and adolescents?
Yes
No
IF YES, Describe your experience of providing services to children and adolescents.
Documents
Resume or CV
Max. file size: 2 GB.
Cover Letter that does not exceed two pages
Max. file size: 2 GB.
Training Program Timeline
Preferred Start Date
MM slash DD slash YYYY
Second Preference Start Date
MM slash DD slash YYYY
Preferred End Date
MM slash DD slash YYYY
Second Preference End Date
MM slash DD slash YYYY
Experience
Current Field Experience Role
Brief Description of Role
Current Professional Role
Brief Description of Role
Academic
Program Currently Enrolled In
Program Graduated From
Special Interests
Please list any interests during your academic or professional career
Describe your experience record keeping in a volunteer or professional role.
Describe your experience with online record keeping.
Please explain your track record for 1) completing projects on time and 2) prioritizing deadlines.
Two (2) Recommendation Letters will be required for your application, if you pass the screening.
Please list two references with their phone number and email. If your Interest Form is selected for a screening and you pass the screening, two recommendation letters will be required to complete your application. Your letters should be written by your references and your references should email the letters directly to maryanneboston@stlpi.org. Your submission of this form indicates that you give your permission for us to contact your references.
References
Special Circumstances: Please consider any special circumstances that may affect your participation in this program (financial concerns, scheduling or personal issues, issues with background check). Email maryanneboston@stlpi.org with these considerations.
Preferred contact method:
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How did you hear about this Program?
*
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