Open Classes Returning Student Application

If you are returned to a blank form upon hitting "next," 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*

First Last

Address*

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

Phone*

Cell Phone

Email*

I am interested in taking the following classes:

Course Titles

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

Yes
No

If yes to videoconferencing/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...)

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 to: Pamela Luttrell, St. Louis Psychoanalytic Institute, 7700 Clayton Rd, Ste 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. Scholarship applications should accompany this form and be submitted by April 15 for first round consideration. Scholarship requests received after April 15 will be granted based on need and available Institute funds.
Upon acceptance a 10% or $150 (whichever is the lesser amount) non-refundable advance course deposit will be charged.
Completed forms may be sent to Pamela Luttrell, St. Louis Psychoanalytic Institute 7700 Clayton Rd, Ste 200, St. Louis, MO 63117 E-mail to: office@stlpi.org

Open Analytic Theory Classes - Returning Students/Faculty Application