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  • Home
  • About
    • Resources in Psychoanalysis
    • Officers of the Organization
    • Continuing Education Grievance Procedure
  • Events
  • Consultation Groups
    • Features
    • Mentoring Program
    • Curriculum
    • Small Group Case Conference
    • Personal Therapy
    • Faculty
    • Tuition
    • Apply
  • Join Us
  • Find a Clinician
  • Contact Us
    • Manage Your Account
    • Special Needs and Suggestions
    • Post An Announcement
    • View Announcements

Apply

To apply to our NC 3P Case Conference program, you may complete the application below and submit it online.

For more information, please contact Dr. Katharine M Nicodemus.

302-245-7877

kmnpsyd@icloud.com

The NC 3P Case Conference Application

MM slash DD slash YYYY
All fields are required!
Name(Required)
Work Address(Required)
Educational Background (College & Graduate Programs)(Required)
Dates
Degree
Institution
 
Please click the plus sign at the end of the row to add up to 4 additional lines.
Current Work Experience
Dates
Employer
Position
Description
 
Please click the plus sign at the end of the row to add up to 2 additional lines.
Previous Work Experience
Dates
Employer
Position
Description
 
Please click the plus sign at the end of the row to add up to 2 additional lines.
Supervision or Consultation (current and previous)(Required)
Supervisor/Consultant
Dates
Frequency
 
Please click the plus sign at the end of the row to add up to 1 additional lines.
Personal Analysis or Therapy (Your therapist will not be contacted.)
Therapist or Analyst
Session Frequency
Dates: From/To
Approximate Total # of Sessions
 
Please click the plus sign at the end of the row to add up to an additional line.

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  • Home
  • About
    • Resources in Psychoanalysis
    • Officers of the Organization
    • Continuing Education Grievance Procedure
  • Events
  • Consultation Groups
    • Features
    • Mentoring Program
    • Curriculum
    • Small Group Case Conference
    • Personal Therapy
    • Faculty
    • Tuition
    • Apply
  • Join Us
  • Find a Clinician
  • Contact Us
    • Manage Your Account
    • Special Needs and Suggestions
    • Post An Announcement
    • View Announcements