APS Application Form

Applicants for the post-doctoral fellowship should have completed their doctoral degree in clinical, counseling, or school psychology and a pre-doctoral internship in psychology before beginning post-doctoral training. The graduate program must be from an American Psychological Association (APA) accredited or ASPPB/National Register designated program, and an APA accredited pre-doctoral internship is preferred.

Applicants for the practicum positions must be enrolled in an American Psychological Association (APA) or ASPPB/National Register designated graduate-level program in clinical, counseling, or school psychology, or APA accredited respecialization program in clinical psychology. This position and experience typically comes before the pre-doctoral internship in psychology.

Before completing this form, please be prepared to upload the following documentation:

Formal Cover Letter,
Curriculum Vitae (CV),
Reference Contact Information,
Testing Experience Summary, and
De-Identified Work Sample.

*If you are unable to upload files using this form for any reason, please e-mail them to Dr. Todd George (todd@drjtoddgeorge.com) and Dr. Andy Gothard (andy@drgothard.com). You may also contact us before applying if you have questions about the qualifications for the training position.

Date

How did you find out about this position?

Applicant Name*

First NameLast Name

Applicant Date of Birth*

Date

Applicant Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number *

Area CodePhone Number

Email*

example@example.com

Upload your Formal Cover Letter

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Desired Position*

PracticumPost-Doctoral FellowPsychometristOther

When do you anticipate starting this position?

(i.e., Fall, Spring, Summer, or specific date if known)

Are you looking for full time or part time?

Are you comfortable conducting face to face evaluation or therapy services?

(Optional) Check all day(s) of the week you could potentially be available for the position.

Which populations are you okay working with in this position? (select all that apply)

Young Children (0-2 years old)Children (2-12 years old)Adolescent (12-18 years old)Adults (18+ years old)

When would you ideally like to know a decision about the position?

If you are currently enrolled as a student, select your school below. If your school is not listed, choose "other" and include the name in the space below.

Name of school if not listed above:

Please provide your educational background and licenses or certification below: *

	Name of school or organization	Degree or credential	Program name or field of study	Year completed/ anticipated
COLLEGE / UNDERGRADUATE
GRADUATE / PROFESSIONAL
GRADUATE/ PROFESSIONAL
CERTIFICATE & LICENSES
CERTIFICATE & LICENSES
CERTIFICATE & LICENSES

Upload your Curriculum Vitae (CV) or Resume

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Optional - If not outlined in your CV, you may use the following space to share about any additional specialized experience, volunteer work, training, or skills you would like for us to consider:

Please complete the following chart based on your psychological testing experiences:

	# of administrations	Interested in more experience with this measure?
Autism Diagnostic Observation Schedule (ADOS)
Minnesota Multiphasic Personality Inventory (MMPI)
NEPSY Developmental Neuropsychological Assessment
Wechsler Abbreviated Scale of Intelligence (WASI)
Wechsler Individual Achievement Test (WIAT)
Wide Range Achievement Test (WRAT)
Wechsler Intelligence Scale for Children (WISC)
Wechsler Adult Intelligence Scale (WAIS)

How many integrated evaluation reports have you completed (approximate)?

Test List & Experience

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Please provide a list of all psychological tests you have given and approximate number of administrations.

Work Sample

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Please upload at least one de-identified sample report/test write up/work sample.

What kinds of evaluations would you like to be competent in at the conclusion of your training?

Professional References

Please provide the name, relationship, and contact information for at least 2 professional references. By providing this information, you give APS permission to contact them pertaining to your application and experience.

Reference 1 Name*

First NameLast Name

Reference 1 Email

example@example.com

Reference 1 Phone Number

Area CodePhone Number

Reference 2 Name*

First NameLast Name

Reference 2 Email

example@example.com

Reference 2 Phone Number

Area CodePhone Number

Reference 3 Name*

First NameLast Name

Reference 3 Email

example@example.com

Reference 3 Phone Number

Area CodePhone Number

If you have reference letters to provide at this time, you may upload them here.

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If we decide to proceed with the interview process, how do you prefer to do interviews?

I declare that to the best of my knowledge the information I have given is correct and complete.*

I agree

Employment/Training Position Application

Contact Information

Education