Open Analytic Theory Classes Application

If you are returned to a blank form upon hitting "submit," this indicates your form did not go through for processing -- please contact Pamela Luttrell at 314-361-7075 x 322 or e-mail Pamela Luttrell.

Name*

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Employer/school:*

Highest degree attained:*

Post-graduate education:*

Professional Experience:*

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I am interested in taking the following classes:

Course Titles

Gender/Sexualities
Diversity
Borderline
Resistance, Transference, Countertransference
Psychosis

Do you anticipate needing to use video conferencing/distance learning to attend classes/supervision?

YES
NO

If yes to distance learning please state why.

Please let us know if there are any special concerns/circumstances that might preclude you from otherwise taking this course (financial concerns, scheduling...)

ATTACHMENTS - REQUIRED
Please note: for all attachments requested for this application, please create a separate document and attach in a separate e-mail to: Pamela Luttrell. Make sure to include your name on each page.

Questions: Please answer the following questions as fully as possible.
1. What is your educational background?
2. How has psychoanalysis figured in your education?
3. What led you to consider taking this course?
4. (For clinicians) Please describe your practice: what types of therapy/counseling case management are you involved in? How did you arrive at the career you now have? How has an interest in psychodynamics impacted your career to date? What kind of clinical career do you hope to have in the next five years?
5. (For researchers) Please describe your research interests. How has an interest in psychoanalysis impacted your research to date? How did you arrive at the career you now have? Where do you see your career going in the next several years? If you are not now a clinician, do you see this as a potential interest in the future?
6. What do you hope to get from this course?
7. Given your background and interests, what perspectives do you anticipate you could bring to this course?

Acceptance will be on a rolling admission basis. Space is limited. Scholarship applications should accompany this form and be submitted by April 15th. Scholarship requests received after April 15 will be granted based on need and available Institute funds.
An annual resource fee of $120 will be charged to each participant. Upon acceptance a 10% or $150 (whichever is the lesser amount) non-refundable advance course deposit will be charged.
Remaining course fees will be billed by semester. Each semester is 16 weeks long.

Do you wish to apply for financial aid?

Yes
No

For Scholarship Consideration

I am submitting my course application along with a request to 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 on ________. Please mail your financial aid documents including tax return to: Pamela Luttrell, St. Louis Psychoanalytic Institute, 7700 Clayton Road, Suite 200, St. Louis, MO 63117.
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 MERIT SCHOLARSHIP APPLICATION

CLICK HERE FOR NEED-BASED SCHOLARSHIP APPLICATION

Signature

Date

Acceptance will be on a rolling admission basis. Space is limited.

Upon acceptance a 10% or $150 (whichever is the lesser amount) non-refundable advanced course deposit will be charged.
Hit SUBMIT to send application electronically.
Completed forms may be printed off-line and sent to Pamela Luttrell, St. Louis Psychoanalytic Institute 7700 Clayton Road, Suite 200, St. Louis MO 63117, or e-mail to p.luttrell@stlpi.org

Open Analytic Theory Classes - New Student