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 also be interviewed. 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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