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EXTENSION DIVISION APPLICATION
Name
Address
City, State, Zip
Phone (day)
Degree or Training
Evening Course ____ MA ____ or NH____
Please send this form with $50 deposit to: PINE/PSNE Extension DivisionPO Box 920762Needham, MA 02492 ________________________________
Application Information
Eligibility: These courses are designed for psychodynamically oriented students and clinicians of all disciplines, who may be either currently engaged in or post clinical training. Registration is for the entire sequence of seminars in the Fellowship Program.
Fees and Payment Policies: The Fellowship Program fee is $1250 with a deposit of $50 due with the application to secure enrollment. The remaining $1200 is due by September 3. Enrollment will be accepted through July on a first come first served basis.
Additional Information For further information, please call the PINE administrative office at 781-449-8365 or the program coordinators, Karen Weisgerber, Ph.D. at 617-630-1919.
Continuing Education Accreditation: The American Psychoanalytic Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. This activity has been planned and implemented in accordance with the Essentials Areas and Policies of the Accreditation Council for Continuing Medical Education through joint sponsorship of the American Psychoanalytic Association and the Psychoanalytic Society of New England, East. The American Psychoanalytic Association takes responsibility for the content, quality, and scientific integrity of this CME activity. The American Psychoanalytic Association designates this educational activity on an hour for hour basis in category 1 credit towards the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that s/he actually spent in the educational activity. The Psychoanalytic Society of New England, East is approved by the American Psychological Association to offer continuing educational for psychologists. The Psychoanalytic Society of New England, East maintains responsibility for this program. Social Workers may telephone 781-449-8365 for CE authorization number.
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