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

Please complete the form below to apply to the Contemporary Approaches to Psychodynamic Psychotherapy (CAPP) Training Program. 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. Your credit card details will be collected at the bottom of the form.

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

2021 Application Form - CAPP

You will be able to save your inputs and return to this form later by going to the bottom and clicking on "Save and Continue Later." You will then be provided with a URL that can be used to access the form again. The information will not be formally submitted until you hit the submit button at the end.
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, clinical experience and professional activities.
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
CAPP 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.
Price:
Total
$0.00
Credit Card*
Card Details
Cardholder Name
Comments
This field is for validation purposes and should be left unchanged.

Save and Continue Later

2021 Application Form - CAPP

Contact Information for Supervisors

Supervisor #1

Supervisor #2

CAPP Application Fee