Child & Adolescent Psychotherapy Program Application

APPLICATION FOR ENROLLMENT

Please fill in the items below. Along with the application and $100 Application Fee (non-refundable and made out to Chicago Psychoanalytic Institute), please submit the following items:


*Copy of most recent academic transcripts
*Copy of license and certificate of malpractice insurance (must be submitted prior to start of program)
*(3) Letters of Reference

Default Payment Plan for Invoice

PROFESSIONAL ADDRESS:

Emergency Contact Information

Private Practice Experience

Admission Documents


Required for all programs EXCEPT Open Classes and Exploring Psychoanalysis

Required for all programs EXCEPT Open Classes

Required for all programs EXCEPT Open Classes and Exploring Psychoanalysis

Required for: CAPP, PEP, and PSP 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 skip this section if you chose ACH or Bank Transfer option above.)
Would you like your Credit/Debit card auto charged? This allows us to save your card information to process future payments.

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