Please complete the form below to apply to the Fellowship Program.

An application fee of $50 for professionals and $30 for residents, interns, and graduate students needs to accompany this application. Your credit card details will be collected at the bottom of the form.

Any questions can be directed to Adriana Couto Silva, MS, MA, LCPC, or Eileen Boyle at

Fellowship Application Form

  • Examples include but are not limited to she/her/hers, he/him/his, they/them/theirs, etc.
  • Examples include but are not limited to LICSW, LPC, MA, MD, MSW, PhD, PsyD, etc.
  • If you are not licensed or your license type is not specifically listed, please select "Other."
  • MM slash DD slash YYYY
  • List the College/University you attended, your Major/Degree and Date of Graduation.
  • List the name of the Institution, Course/Programs, Dates and Supervisors.
  • List your training & professional experiences. Please describe the modalities of treatment provided, ages of clients, length and frequency of treatment, and type and frequency of supervision received.
  • e.g. research, teaching, community work, writing, etc.
  • Describe your reasons for applying to the program, e.g. its relevance to your work, its relationship to career goals, your interest in psychoanalysis, etc.
  • Drop files here or
    Max. file size: 256 MB.
    • If you will need accommodations, please contact our Administrator at
    • Fellowship Application Fee

    • An application fee is required with the submission of the Fellowship application. Choose the one that is appropropriate:
    • $0.00
    • This field is for validation purposes and should be left unchanged.