Green House Application

First Name*
Last Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Questions:
Please answer the first question, and any two of the remaining questions:
What draws you to consider the Green House program?*
Name one or two specific learnings you have gained, in terms of your clinical understanding and experience, from your own depth/psychodynamic/long-term personal therapy experience?
What interests you about working with marginalized clients? What has your experience (clinical or otherwise) been with this population?
What goals might you have for your learning experience in the Green House program?
What do you imagine the future impact of this program might be for you?
Resume File Attachment*
Accepted file types: pdf, doc, docx, odf.
PDF, DOC, DOCX, ODF
Digital Signature (type full name)*
Today's Date
Date Format: MM slash DD slash YYYY

Application Instructions & Deadlines

Post-Graduate Psychotherapy Training

Application deadline for the 2019 cohort is August 31, 2018, 5:00p.m.

Attend the July Information Meeting on Saturday, July 21 from 2 to 4 pm or speak to Dr. Pat Cochran prior to submitting your application.
Your CV/Resume.
Completed answers to the longform questions.
Upload a copy of your professional license (if applicable).
If you are selected to have an in-person interview, you will be required to have two letters of reference, at least one of which must be from a supervisor who is very familiar with your clinical work.

For more information, download FAQs 2019.

Application Materials Check List:

Completed and signed application form
Resume or CV
Written questions
Copy of your professional license (if applicable)
Two letters of reference (if you are selected for an in-person interview)

Guidelines for Resume/CV:

Please submit your Curriculum Vitae or resume with start and end dates of employment or engagement for each of your clinical experiences. Please be sure to outline your relevant information below:

Current professional status (student, unlicensed graduate)
Training (include names of institutions, degrees and dates)
Clinical or other relevant employment history
Professional clinical license for IL (type, number)
Professional psychotherapy training (list internships, certificate programs, intensive trainings, etc. Please include the sponsoring organizations’ names and dates of participation)
Teaching
Consulting
Research
Publications
Presentations
Other professional experience

If you prefer, you may complete application offline and submit via email. Download the application form, complete offline and submit via email. If submitting via email, you’ll need to print the application, complete it offline and then scan it and save as a PDF. Additional requested documents can also be attached to your email as PDFs. You will email your packet to: Greenlee Brown.