Postgraduate Fellowship Program West Application

Application Process

Accepting and processing applications on a rolling admissions basis until the class is full (with a deadline of August 1). Applications are reviewed as they are received.  Final decisions will be made by _____.

Please note: since we are committed to the educational value of smaller seminars, the limited available spaces may well be filled before the final August 1 deadline.

To apply, please submit the form below with these required attachments:

• Current curriculum vitae (CV)
• Statement of Interest. Please describe your interest in psychoanalytic psychotherapy and what you hope to gain from the fellowship program.
• Two current letters of reference from supervisors or colleagues. It is NOT necessary to send letters of recommendation in a sealed envelope. Please send them electronically. References can be sent as separate emails directly if desired.

For your application to be complete, please also submit a non-refundable $25 application fee.

Pay with PayPal

Note that you do not need to have a PayPal account.

Pay by Check

Mail a check for $25 payable to “MIP” to:

MIP
1330 Beacon Street, Suite 265
Brookline, MA 02446

If the application fee represents a hardship, please contact MIP’s Executive Director for an alternative financial arrangement.

Name:

Address:

Phone:

Additional Phone (leave blank if not applicable):

Email:

Degree, and date received:

Current primary position:

Address at this position:

When did you begin position:

Are you independently licensed?

Board and license number:

Have you ever had your license suspended or revoked? YesNo

Have you ever been involved in a malpractice suit? YesNo

Have you ever been sanctioned or dismissed by any hospital, mental health, or professional organization for ethical violations? YesNo

If you answered "yes" to any of these questions, please attach a separate document with your explanation here.

Additional Documents

Please attach these documents to your application.

Current curriculum vitae (CV):

Statement of Interest:

Reference Letter 1:

Reference Letter 2:

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