The International Class 2017/18 Application Cover Sheet Activities

The International Class 2017/18

Application Cover Sheet

Activities
Three residencies at the Institute in New York City: 7 days in October; 6 days in February; 10 days in June.
Five online seminars in between residencies.
Skype Conference Calls
Fee
$3,400USD.
Not Included
Transportation costs to NY and food and housing while in NY are the responsibility of the applicant.

Signature _____________________________________________________________

Date _________________________________________________________________

No handwritten applications will be accepted. Send applications to the attention of Lois Holzman at [e-mail]

EAST SIDE INSTITUTE FOR GROUP AND SHORT TERM PSYCHOTHERAPY

The International Class Application

Given Name ________________________ Family name_________________________

Current Title/Organization Affiliation _________________________________________
Address_______________________________________________________________
City___________________________________State___________________________
Zip/Postal Code______________Country_____________________________________
Telephone_________________________Cell _________________________________
Email_________________________________________________________________

EDUCATION (BACHELOR’S AND ABOVE)
Institution__________________________________________________________________
Years Attended_____________Degree________________________________________________
Department and/or Concentration_______________________________________________________________

Institution__________________________________________________________________
Years Attended_____________Degree________________________________________________
Department and/or Concentration_______________________________________________________________

PROFESSIONAL EXPERIENCE (INCLUDING INTERNSHIPS)
Institution__________________________________________________________________
Title/Position________________________________________________________________
Dates__________________________

Institution__________________________________________________________________

Title/Position_______________________________________________________________
Dates__________________________

Institution__________________________________________________________________

Title/Position_______________________________________________________________
Dates__________________________

PROFESSIONAL INTERESTS

In an essay of 500-1000 words, describe your experience and interests and how they led you to want to study at the Institute. Include specifics about the Institute’s methodology that attract you and why.

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