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  • Home
  • About
    • Resources in Psychoanalysis
    • Officers of the Organization
    • Continuing Education Grievance Procedure
  • Events
  • APP
    • 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 APP program,  you may complete the application below and submit it online, or download a copy here and mail it to:

APP — NC3P
c/o Tennyson Dodd
524 Inwood Drive
Nashville, TN 37211

For more information, please contact any of the Co-Directors:

Dr. Jeff Binder 615-358-8073

Tennyson Dodd 615-358-8073

Advanced Psychodynamic Psychotherapy Application

MM slash DD slash YYYY
All fields are required!
Name(Required)
Work Address(Required)
Home 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.
References - Please list two references who know you and your work as a psychotherapist. Your signature on this application form indicates that you give your permission for us to contact the references listed below.(Required)
Name
Address
 
Please click the plus sign at the end of the row to add an additional line.
There is a $60 application fee. Please use the button below to complete the payment. I understand that my application and progress within this program will be subject to assessment by the instructors in the program and agree to abide by this assessment.

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  • Home
  • About
    • Resources in Psychoanalysis
    • Officers of the Organization
    • Continuing Education Grievance Procedure
  • Events
  • APP
    • 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