APPLICATION FOR APPOINTMENT
POSTDOCTORAL PSYCHOLOGY FELLOWSHIP
DIVISION OF BEHAVIORAL MEDICINE
Saint Louis Behavioral Medicine Institute
Department of Community and Family Medicine
Saint Louis University
Personal Information:
Name:
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Date:
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Home Address:
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Home City, State, Zip:
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Home Phone:
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Office Address:
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Office City, State, Zip:
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Office Phone:
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Colleges and Universities Attended, Dates, Degrees, Major:
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Predoctoral Internship, Dates, Rotations:
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References:
Director of Clinical Training:
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Major Clinical Supervisor:
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Other Clinical Supervisor:
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Dissertation Director:
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Degree Requirements:
Estimated Date When All Degree Requirements Will Be Completed:
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Dissertation Topic or Title:
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Describe Current Stage of Dissertation:
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Papers Presented - Please attach copies of pertinent publications:
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Remarks:
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Goals and General Interests:
The following sections are intended to cover both your long-range plans and your more immediate interests. We hope to learn more about what your likes and preferences are as they pertain to clinical and research interests and activities. Please answer these questions both frankly and openly. To the extent that the questions themselves are off target as far as you are concerned, please feel free to add your comments. Use additional sheets as necessary.
A. Please describe briefly your long-range plans as you see them now. We are interested in your current feelings about long-term plans, whether you feel relatively sure about them or quite undecided.
B. Describe your goals for the coming year or years in this postdoctoral fellowship, as far as you understand the training opportunities available in this setting. Write a description of the clinical training program which you would be interested in pursuing. What types of clinical activities and learning experiences would you like to be involved in? How would you apportion your time among them?
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