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Application Form - Psychoanalytic Training (Check)

  • Date Format: MM slash DD slash YYYY
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  • Please list your current insurance carrier.
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  • List the College/University you attended, your Major, # of Credits, Degree and Date of Graduation.
  • List the name of the Institution, Course/Programs, Dates and Supervisors.
  • List your training & professional experiences, listing most current first. Include Dates, Client Age Range, Treatment Modality, Setting (Hospital/Clinic), Hours per Week, and Supervision (Type, Individual, Peer, Group, etc., and Frequency).
  • e.g. research, teaching, community work, writing, etc.
  • List the type of psychotherapy (individual, family, couples, group), the therapist's name(s) and theoretical orientation(s), when, how often, and how long.
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  • Your autobiographical statement should be approximately five pages indicating your reasons for pursuing psychoanalytic training, aspects of your personal and childhood history including family background and later development, relative strengths and weaknesses, future professional plans including the possibility of relocation.
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  • Contact Information for References

    Please indicate the names and addresses of three mental health Professionals who are familiar with your work to serve as references. Please ask them to send letters to ICP+P Psychoanalytic Training Program, 4601 Connecticut Ave., NW, Suite 8, Washington, DC 20008.
  • References #1

  • References #2

  • References #3

  • Application Fee - Psychoanalytic Training

  • 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, 4601 Connecticut Ave., NW, Suite 8, Washington, DC 20008.
    Price: $50.00
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