New Psychoanalytic Education Program

Psychoanalytic Education Program

Instructions:

Please fill in the fields below. Please submit application materials by April 15th. Due to limited slots, international applicants should submit applications as soon as possible. Each applicant will complete a series of personal interviews. Along with the application and $200 application fee (non-refundable), please attach the following items or submit via e-mail to achandler@chicagoanalysis.org:

• Case Write-Up: We ask that you submit 5-10 typed pages of a case currently in treatment, but one that is not supervised. You are encouraged to choose a case that may be problematic or challenging. Applicants with academic or non-clinical backgrounds are asked, instead, to provide an example of their scholarly work.

• Copy of most recent academic transcripts

• Copy of license (if applicable) and certificate of malpractice insurance

• (3) Letters of Reference

• Your current curriculum vitae/resume.

First Name

Middle Name

Last Name

Street

City

State/Province

Zip/Postcode

Cell Phone

Home Phone

Birth Date

Gender

Ethnicity

Country of Citizenship

Emergency Contact Information

Contact Name

Relationship

Cell Phone

Profession Information

Work Address

Work City

Work State/Province

Work Zip/Postal Code

Work Phone

Admission Documents and Information

License #:

License Expiration:

License Type:

Copy of Professional License

Required for: PEP, PSP, APP, APP+2, & CAPP

Name of Insurance Company

Policy Number

Professional Liability Insurance Expiration:

Copy of Professional Liability Insurance (Please upload a new copy each year)

Required for: PEP, PSP, APP, APP+2, and CAPP

Curriculum Vitae/Resume

Most Recent Transcript

Required for all programs EXCEPT Open Classes and Exploring Psychoanalysis

Case Write-Up

Required for: PEP and PSP programs only

Payment options

If you select the ACH or Bank Transfer Payment method, the Institute will email you an Invoice which will contain a payment link. The Transaction fee will be 1.5% of the Total Balance or $1.00, whichever is larger.
If you select payment by Credit or Debit card, after you click the Submit Application button, you will be directed to a payment page to enter your card information. Students paying by ACH or Bank Transfer will need to ignore the Payment page.

Please select your Payment Method here:

(Please skip this section if you chose ACH or Bank Transfer option above.)
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