Application for CAPP Training Program - Payment by Check - Institute of Contemporary Psychotherapy and Psychoanalysis

Please complete the form below to apply to the Contemporary Approaches to Psychodynamic Psychotherapy (CAPP) Training Program and pay by check. In addition, two recommendation letters from former supervisors are required. They can be emailed directly to Dr. Sandmeyer.

An application fee of $50 needs to accompany this application. If you choose to pay that fee by check, continue the application on this page. If you prefer to pay by credit card, please click here to go to a different page to complete the application.

Any questions can be directed to Janna Sandmeyer at jannasandmeyer@me.com.

2021 Application Form - CAPP (Pay by Check)

Name*
First Last
Date of Birth
MM slash DD slash YYYY
Home Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Phone Number*
Email*
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone
Preferred Mailing Address
- Home Address
- Business Address
Attach a copy of your most recent CV that details your education and clinical experience.
Drop files here or
Max. file size: 256 MB.
Attach a copy of your Current License
An LGSW, LPC, or other equivalent license must be established by any student seeking LCSW or PhD licensure while in the program.
Drop files here or
Max. file size: 256 MB.
Attach a copy of your Current Malpractice Insurance Coverage
Individual malpractice insurance must be current except if working exclusively under another agency’s or institution’s insurance. ICP+P consultants will not assume liability for student malpractice.
Drop files here or
Max. file size: 256 MB.
Personal Psychotherapeutic and/or Psychoanalytic Experience
List the type of psychotherapy (individual, family, group), the therapist's name(s) and theoretical orientation(s), when, how often, and how long.
Please describe your interest in the CAPP program.
What is it about CAPP that appeals to you, and why at this particular point in your professional development?
Attach files here if you do not have adequate room in the designated spaces above or upload your CV here as well.
Drop files here or
Max. file size: 256 MB.
Contact Information for Supervisors
Please submit the names and addresses of two or more mental health professionals who have supervised your work. A letter is also requested but can be submitted separately.
Supervisor #1
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Email - Supervisor #1
Supervisor #2
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Email - Supervisor #2
CAPP Application Fee
Application Fee*
A $50 application fee is required with the submission of the training application. This fee is non refundable, but will be applied to your tuition. You have chosen to pay the application fee with a check. Please make the check payable to ICP+P and send to ICP+P, 3298 Governor Drive, Suite 22270, San Diego, CA 92192.
Price:
Name
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Application for CAPP Training Program – Payment by Check

2021 Application Form - CAPP (Pay by Check)

Contact Information for Supervisors

Supervisor #1

Supervisor #2

CAPP Application Fee