Application for Admission to Certificate Program

Use this form to submit your initial application to the Admissions Committee. After you submit your initial information using this form, you will need to mail additional materials, noted in the checklist below, along with your application fee.

<b>NOTICE OF NONDISCRIMINATORY POLICY FOR CANDIDATES</b>

The Psychoanalytic Institute of Northern California admits candidates of any race, color, age, sexual orientation, or national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to candidates at the Institute. PINC does not discriminate on the basis of race, color, age, sexual orientation, or national and ethnic origin in admissions, in its educational policies or other Institute-administered programs.

    Checklist of documentation to include with your application

    1) Curriculum Vitae* 2) Copy of your current mental health license 3) Proof of liability insurance coverage 4) Statement of Interest*: Please include an essay of 3-4 pages explaining why you have decided to apply for psychoanalytic training. Include those aspects of your experience you think will help us evaluate your application. You may use some or all of the following questions to organize your essay. These are included as suggestions only: a) What do you see as your strengths as a therapist; as a potential analyst? What do you see as your shortcomings? b) What experience in the last several years of your professional life has had a lasting impact on you? c) Has there been some experience in your personal life that has affected your thinking about psychotherapy or the way you work? d) In what ways do you think your work as a therapist has changed during the course of your career? What do you think have been the major influences bringing about the changes? *May be sent via email to pincsf@gmail.com

    Personal Information

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    References

    Please ask three individuals (supervisors, colleagues or others) who are familiar with your clinical work, other than your analyst/therapist, to submit a letter on your behalf discussing in detail whatever they consider relevant to your plans for psychoanalytic training to pincsf@gmail.com. The Admissions Committee may contact these individuals for additional information about your work. Please list the individuals you have asked to submit letters on your behalf below.

    First Reference

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    Second Reference

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    Third Reference

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    Final Steps

    After you electronically submit this application, please send the rest of your application materials (noted in the checklist above) along with the $220 application fee (payable to the Psychoanalytic Institute of Northern California) to the PINC Office. You may send your CV, Statement of Interest and Reference Letters digitally to pincsf@gmail.com. Your copy of your current mental health license and proof of liability insurance coverage, along with your payment, should be sent hard copy to: PINC Attn: Admissions Committee 530 Bush Street, 7th Floor San Francisco, CA 94108 If you have questions, please call Dr. Maureen Murphy at (415) 922-4013 or email at pinc93@earthlink.net Please note: Your application is not considered complete until we receive the rest of your materials and your reference letters. After we review your written application and letters of reference, you will be contacted by a member of the Admissions Committee who will inform you as to whether you will be offered interviews.