Judy Byck Scholarship Application

Created by donations from family, friends and colleagues, the Judy Byck Scholarship Fund honors the memory of a remarkably gifted clinical social worker and expresses her intention that clinical social workers new to our organization be given the opportunity to study psychoanalytic concepts and approaches to psychotherapy.

Judy Byck Scholarships will be given to MSW graduate social workers who have never taken a course at the Psychoanalytic Center of the Carolinas. Once approved, Byck Scholars will have the opportunity to attend one course with the full cost of tuition waived during the upcoming academic year.

Please provide a current curriculum vitae or other documentation containing the following information, if applicable:

1. Education: List academic degrees, years awarded, institutions, locations, and majors or areas of specialization.

2. Clinical training: List sites and dates of all internships, residency programs, fellowships, practicum placements, advanced certificate training, or any other formal supervised training, with names of direct supervisors and dates of supervision.

3. Professional Experience: Provide all post-training employment with dates and brief descriptions of the nature of the clinical work. Include private practice.

4. Supervision: List major supervisors, starting and ending dates, frequency, focus (continuous case or most urgent case), and format (individual/group).

5. Psychoanalytically oriented studies: List coursework, workshops, or other psychoanalytic study, with dates, instructors, and sponsoring organizations.

6. Other studies and work experience relevant to your interest in psychoanalytic psychotherapy, e.g., work in another field, or independent reading, or research.

7. Writing: Provide a bibliography of publications and papers presented, and a brief description of any unpublished research, clinical, or theoretical writings.

8. Teaching Experience: List courses or seminars taught; include dates, locations, sponsoring organizations, and topics.

9. Supervising Experience: Include dates, locations (e.g., agency, private practice, institute), number of individuals, number of hours, format (individual/group), and types of supervisees (students/professionals).

10. Professional Affiliations: List names of professional societies and organizations and dates of membership.

11. Current clinical practice: Include approximate number of clinical hours per week, clientele (adult, child, families, etc.), modes of treatment, types of problems treated, usual frequency of treatment, etc.

Please include a brief personal statement that demonstrates one or more of the following:

• Interest in the application of psychodynamic principles to any area of clinical care
• Commitment to developing oneself as a psychotherapist by deepening one's knowledge and understanding of one's own inner processes and by learning to apply that understanding in the therapeutic relationship.
• Curiosity and intellectual capacity to undertake further psychoanalytic study

I certify that all information provided on this Application, or submitted with it, is accurate to the best of my knowledge. I specifically authorize the Psychoanalytic Center of the Carolinas and its authorized representatives to consult with the third parties whose names I have given either herein or otherwise, as well as with any third parties whose names I may in the future provide as references, concerning further information bearing on my application. I release from any and all liability the Psychoanalytic Center of the Carolinas and their authorized representatives, and any third parties whose names I have provided or may provide, for any acts, communications or disclosures involving me, including otherwise privileged and confidential information relating to me and this application. I acknowledge that the Psychoanalytic Center of the Carolinas reserves the absolute right to accept or reject any applicant for any reason(s) deemed sufficient by the Psychoanalytic Center of the Carolinas in its sole discretion.

If you have questions about the scholarship program and your eligibility, please contact Byck Scholarship Chair Natalie Peacock-Corral, nataliepeacockcorral@gmail.com.