Rev: May16 Page 6 of 6 File: FPC Application
In addition to the above material, please submit:
1) A typed autobiography (approximately 1,000 words). The purpose of the autobiography
is to allow the Admission Subcommittee to assess your ways of understanding your own
development as a person, the important relationships and events which have
contributed to your live and the origins of your interest in psychoanalysis.
2) A typed narrative (approximately 1,000 words) of your career development, current
focus, objectives, etc.
3) A copy of your curriculum vitae.
4) Copies of your two most recent publications, if applicable.
5) Documentation of current clinical licensure and of professional liability insurance.
During your evaluation interviews you will be asked to discuss your clinical work with patients.
You may supplement this, if you wish, by also submitting along with this application, a brief
clinical report on a patient whom you have treated in psychotherapy.
I hereby authorize the Florida Psychoanalytic Center to write to the above-named references
and institutions and authorize the above-named references and institutions to release
information relevant to my application to the Florida Psychoanalytic Center. I understand that
this release does not include, nor will the Subcommittee contact, those whom I have listed as
personal analysts or therapists. I also understand that during the evaluation interviews, I may
be asked about my treatment experiences.
I attest that, to the best of my knowledge, all of the above information is true, correct and not
misleading.
Signature _____________________________________________________
Date of Application _______________________________
Application Fee: A check for $350, made payable to Florida Psychoanalytic Center, should
accompany this application.
