www.beckinstitute.org - Training Program Application

TRAINING PROGRAM APPLICATION

Thank you for your interest in the Beck Institute Training Programs. We are pleased that you have decided to apply to one of our programs. Applicants must hold at least a Master's degree in a mental health, medical, or related field to apply to the Extramural Training Programs or the Cognitive Therapy Workshops. Applicants to the Community Mental Health Center (CMHC) Cognitive Therapy Training Program must hold at least a Bachelor's degree. The full description of each training program is posted on our website under "Training." If you have not done so already, please take the time to familiarize yourself with the program you'd like to apply to before submitting your application.

DOCUMENTS REQUIRED TO COMPLETE THE ONLINE APPLICATION:

Curriculum Vitae (CV) (required for ALL training applicants)
Letter of Reference (required only for Extramural training applicants, and not Cognitive Therapy Workshop applicants)

As part of the application, you will be required to upload a copy of your curriculum vitae (CV). The application will not be accepted without a CV attached. If you are applying for Extramural Training, you will also be asked to have a letter of reference sent to us by fax or regular mail on official letterhead within two weeks of submitting your application. Reference letters can be faxed to us at (610) 664-4437, or mailed to the address below:

Please be sure to fill in every field of the application, or mark a field N/A if it does not apply. If you have any questions, please let us know. We look forward to reviewing your application. Thank you again for your interest in the Beck Institute Training Programs.

Note: Please be aware that your session will expire in 60 minutes if there is no activity (REVIEW/PRINT; Upload; SUBMIT). If so, your application will be abandoned.

PART ONE: Personal Information

User ID:

Select a User ID from 5 - 30 characters in length. You may use letters, numbers, and underscores.

First Name:

Last Name:

Full Name:

Exactly as you would like it to appear on official correspondence, with your degree(s).

Gender:

Title/Position:

Setting/Organization:

Work Address:

Street:
City:
State/Province:
State:
Province:
Zip/Postal Code:
Country:

Phone(W):

Country Code

Phone #

Fax(W):

Email(W):

Home Address:

Street:
City:
State/Province:
State:
Province:
Zip/Postal Code:
Country:

Phone(H):

Country Code

Phone #

Fax(H):

Email(H):

Send Correspondence to:

Work Address Home Address

May we correspond with you by email, rather than regular mail?

Yes No

Degree:

Highest Degree:
Field:
Institution:
Date Earned:	Licensure: Yes No
State(s)/Country of Licensure:

I currently do the following (check all that apply):

Treat clients Supervise or teach students/clinicians
Conduct research Other

My psychotherapy practice includes the following (check all that apply):

Inpatients	Children	Couples therapy
Outpatients	Adults	Family therapy
Adolescents	Geriatrics	Group therapy
Individual sessions	Partial hospital patients	Medical population
Other

Please briefly describe your predominant therapy orientation and training, if not specifically cognitive.

Briefly describe your exposure to cognitive therapy (e.g., articles, books, tapes, workshops, courses, supervision).

Is there any other information about you that would be helpful to us in evaluating your application?

PART TWO: Training Programs

How did you learn about our training programs?

I am interested in applying for the following program:

Extramural Program for Therapists and Supervisors (6 Months, Weekly Supervision)

Tuition Cost: $4,550.00, Deposit: $300.00

A $300 deposit is due upon acceptance of your application. The remainder of your tuition is payable in two installments.