APPLICATION
Postdoctoral Training in Clinical Psychology
University of Michigan - VA Ann Arbor Consortium
V. 04 November 2010
Name: __________________________________________
Address: ________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Graduate Degree: ______________ Major:____________________________________
Department/University: ____________________________________________________
APA approved? Yes
No
What is the status of your dissertation? (You can not start the fellowship until you have successfully
defended your dissertation and completed all requirements for the doctorate.)
Done on (date) _____________
Defense has been scheduled for (date) _____________
In Progress - defense expected on or around (date) _____________
Internship Institution: ____________________________________________________
Date Completed: _______________ APA approved? Yes No
Citizenship (VA postdoctoral fellows must be US Citizens)
US ____
Other ____
Track to which you are applying (Please check as appropriate. If applying to more than one track (a, b, c or d
below) please submit a separate application for each track:
a. Clinical Adult Psychology
University of Michigan* _____
Veterans Administration _____
Both ______
b. VA-SMITREC (Adult)_____
c. UM Clinical Child & Adolescent Psychology Specialty* ______
d.
Clinical Neuropsychology Specialty - (no child neuropsychology slots for 2011-2012)
Program Code Number Research/Clinical emphasis Area
(OK to check one or more)
____9512
____9513
____9514
____9515
GENERAL ADULT NEUROPSYCHOLOGY*
GERIATRIC NEUROPSYCHOLOGY*
NEUROPSYCH OF MOOD DISORDERS*
VA HCS/GERIATRIC NEURO/TBI NEURO
*APA Accredited
NB: If you are applying for a fellowship in Neuropsychology, you will also need to enter the APPCN
Match http://www.natmatch.com/appcnmat/. See http://www.natmatch.com/appcnmat/nerdate.htm
for significant dates in the match process.
Date Available for Starting of Fellowship:* ____ /____ /_____
*The starting dates for University of Michigan fellowships are either ~July 1, 2011 or ~September 1, 2011. The
starting date for the VA fellowships is August 29, 2011. You must have successfully defended your dissertation
in order to start this fellowship.
Along with this application, please submit:
1) A copy of your curriculum vitae;
2) Three (3) letters of recommendation, including one from your Graduate Program's Director of Clinical
Training, one from a primary clinical supervisor, and one from someone who can address your
preparation for advanced training in your chosen area of specialization;
3) An official graduate school transcript;
4) A detailed cover letter, in which you describe your background in Clinical Psychology, including the
approximate number of practicum/internship assessment and intervention hours you have or will have
completed by the start of the fellowship, and a description of these activities. Since this fellowship is
approximately 50% research training, describe in the letter your research interests and training. Indicate what
you would hope to gain from this fellowship and how that relates to your future career goals.
Mail to:
UM-VA Psychology Postdoctoral Consortium
c/o Allison Novara
2101 Commonwealth Blvd., Ste C.
Ann Arbor, Michigan 48105
The deadline for applications is January 15, 2011, but applications after that date may be considered. For
the Neuropsychology specialty, the Match and notification of acceptance will be made in March of 2011.
Notification may be earlier for the Adult and Child & Adolescent tracks. Check Web page for up-to-date
information: http://www.umich.edu/~gusb/post-doc.html (last revised 11/08/2010)
*APA Accredited