ONE YEAR INTRODUCTORY PROGRAM IN
RELATIONAL PSYCHOTHERAPY
APPLICATION FORM
2008-2009
Date_________________________
Name of Applicant
______________________________________________________
Address_______________________________________________________________
______________________________________________________________________
Telephone Numbers
Home__________________ Work____________________
Cell_________________
Email________________________________________________
Graduate Education (Please specify advanced degree, school,
and area of study)
___________________________________________________________________________
Profession
______________________________________________________
License Number __________________License eligible:
Yes____No____
How did you hear about the
program_______________________________________________
In
no more than one page, please specify why you are
interested in this program (please attach).
Days of the week and hours of the day
available for an interview:
APPLICATION
REQUIREMENTS:
Applicants are required to have an
advanced degree in a mental health field and be licensed or
license eligible in a mental health profession.
Please submit:
A completed application
form
A copy of the applicant’s curriculum vita
A copy of professional license
A copy of
graduate transcript if unlicensed
Completed
applications must be received by May 16, 2008 and should be
mailed to:
The Stephen A. Mitchell Center for
Relational Studies
127 West 79th Street, Suite 3
New York,
NY 10024
Applicants who are being considered
for admission will be interviewed by at least one member of
the faculty.