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 San Diego Psychoanalytic Center 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 San Diego Psychoanalytic Center 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 San Diego Psychoanalytic Center reserves the absolute right to accept or reject any applicant for any reason(s) deemed sufficient by the San Diego Psychoanalytic Center in its sole discretion.
I further understand that photographs and/or video recordings may be taken during fellowship-related events and activities. By participating, I grant permission for my likeness to be used by the San Diego Psychoanalytic Center for promotional, educational, and marketing purposes across print, digital, and social media platforms. I understand that I may opt out of such use by notifying the Center in writing in advance.