Austin Psychoanalytic Mentoring Application
Note: Participation in the Mentoring program requires membership in Austin Psychoanalytic.
Please enter a valid phone number.
Granting Institution (Or current institution)
Type of Degree
Licensure / Credential
Agency / Type of practice (Please describe work that you do.)
Do you have a specialization or particular area of interest? If so, please describe.
What piqued your interest in having a mentor?
What might you want to focus on with your mentor?
What led you to your interest in psychoanalytic / psychodynamic thinking and/or it's application to your clinical work?
Preferences for location (check ALL that apply)
Preference for meeting times (Please include any specific day/time preferences under "other"
Are you able to attend at least one Austin Psychoanalytic monthly meeting in the fall and spring?
Are you a member of Austin Psychoanalytic
Please share with us any other factors you would like us to consider when matching you with a mentor. (Such as age, culture / ethnicity, mobility restrictions, etc.)
How did you hear about mentoring program?
Should be Empty: