Application : Screening Interview

Individual Membership in the IAAP

Application for a Screening Interview towards
Individual Membership in the IAAP

Name:_____________________________________

Address:

    ______________________________________________________

    ______________________________________________________

    ______________________________________________________

phone:__________________________; fax:__________________

email:______________________________

Date of birth:__________________________

Country of citizenship:_________________________;

Permanent residence if different from present address:

    ______________________________________________________

    ______________________________________________________

    ______________________________________________________

Hours of analysis with IAAP members: __________

    (to be verified with letters from all IAAP analysts stating only the total number of hours of analysis and the dates between which these were given).

Hours of supervision with IAAP members: ________

    (to be verified with letters from all IAAP analysts stating the total number of hours of supervision and the dates between which these were given as well as a completed Consultation Evaluation Form filled out by each supervisor)

Along with this application please include:

    Curriculum Vitae that includes information about academic background, professional training, and experience as a psychotherapist;

    Professional Autobiography with analytical insights and reflections (approximately 10 pages, double spaced in English);

    A brief statement about eligibility (see requirements on the IAAP webpage, "Individual Training & Membership" :  go to Main Menu (top) > to IAAP Overview > to Individual Membership;

    A list of any previous applications for analytic training, including the name of the Group Members, the dates of the applications, and the outcomes.

Upon receipt of all documents, applicants will be notified whether or not they will be accepted for a screening interview. If accepted for an interview, this will be arranged by the Individual Membership subcommittee of the IAAP; a fee is assessed for this interview, details to be provided upon scheduling.

Before signing this application please read the IAAP Code of Ethics for Individual Members, which can be found on the IAAP's website : go to Main Menu (top) > to IAAP Overview > to Individual Membership  or  for more information go to Main Menu (top) > to IAAP Overview > to Governing Documents > to Ethics Committee.  The Code of Ethics for Individual Members is also included under the documents for Download (Main Menu).

____ I have read the IAAP Code of Ethics for Individual Members and if I am accepted as a router I agree to abide by this code throughout the time I am in route.

____ I agree to be under the jurisdiction of the IAAP's Ethics Committee as long as I am pursuing Individual Membership in the IAAP.

____ I declare I have no outstanding ethic complaints or findings against me.

____ I hereby agree to abide by and follow the IAAP policy of non discrimination on the basis of race, religion, ethnic origin, gender and sexual orientation (located under IAAP Overview > Individual Membership). 

Applicant's signature: ______________________________________________

Date: _________________________________

Contact:
IAAP Ethics Secretariat: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Note : You can select "Download" from the Main Menu and download "Application for Screening Interview" from the section for Individual Membership.  The application is available in MS Word and PDF formats.