Comprehensive MedPsych Systems, Inc.

1250 South Tamiami Trail, Suite 201

Sarasota, FL 34239

941-363-0878 / Fax 941-363-0527

Last update, 1/9/14

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POSTDOCTORAL NEUROPSYCHOLOGY RESIDENCY TRAINING PROGRAM

Director of Training:Geoffrey Kanter, Ph.D.ABN, ABPdN

RESIDENCY APPLICATION FORM

Instructions:Please observe CMPS Postdoctoral Neuropsychology Training Manual for additional details ( this form in entirety, ensuring accuracy and all requested detail.

Applicants with disabilities: Applicants with disabilities are encouraged to apply and to contact the Director of Training, Dr. Geoffrey Kanter, to discuss any needs in regard to the application and interview process.

Correspondence:All program-related inquiries and application-related inquiries should be directed to Dr. Geoffrey Kanter, Director of Training, Comprehensive MedPsych Systems, Inc.

Deadline:All application materials must be received by 12:00 midnight EST on July 15 in order to be eligible for consideration.

Date:

Name:

U.S. Citizen: Choose an item.Resident Status:

Mailing Address:

Preferred Phone:Email:

Academic Program Completion

Doctoral Degree in Psychology Academic Program: Choose an item.

Program Accreditation Type: Choose an item.

Date of Degree Requirement Completion:

Program Institution:

Program Department:

Internship Completion

Did your program meet APPIC,CPA, or APA standards?(Check all that apply)

Prior Neuropsychology Training (Check all that apply)

Coursework Doctoral Practicum Pre-Doctoral Internship

Three Required References

APA Graduate Program Director (DCT) (required; must confirm anticipated graduation date)

Name: Phone:

Pre-Doctoral Internship Director (required; must confirm successful completion of internship)

Name: Phone:

Other: Title/Affiliation:

Name: Phone:

NOTE: Three letters of reference must be submitted directly to Dr. Kanter from: (1) your APA-accredited Graduate Program Director (DCT), (2) your pre-doctoral internship director, and, (3) a reference of your choice. Reference letters may be submitted via email or hard mail, though must be sent directly from the reference sourceto Dr. Kanter.

Are you fluent in American Sign Language (ASL)? Yes No

List all other fluent language abilities:

How did you hear about our Post-Doctoral Program? (Please check all that apply):

Former Post-Doctoral ResidentCMPS Website

At InternshipOther (explain):

DOCUMENTATION SUBMISSION

After completion of this application form, please email it along with all required documentation,as outlined in the following checklist, to the Director of Training, Dr. Geoffrey Kanter at r, mail hard copies to:

Geoffrey Kanter, Ph.D.ABN, ABPdN

RE: Postdoctoral Residency Training

Comprehensive MedPsych Systems, Inc.
1250 S. Tamiami Trail
Suite 201
Sarasota,Florida34239

Residency Application Form (available at

Cover letter (including a statement of career goals, statement of interest, not exceeding two

single-spaced pages)

Resume or curriculum vitae (particularly summarizing education and training)

One written de-identified sample report

Neuropsychology Training Content Survey(attached to Residency Application Form)

Letters of recommendation (to be sent by reference sourcesas detailed above)

Interview Selection and Position Notification: Please observe CMPS Postdoctoral Neuropsychology TrainingManual for details (

NEUROPSYCHOLOGY TRAINING CONTENT SURVEY

The CMPS Postdoctoral Neuropsychology Training Program follows the Houston Conference outline of knowledge base areas in neuropsychology. As the postdoctoral training experience is a time during which Trainees should seek to acquire all unmet knowledge core areas, CMPS endeavors to focus didactic and other training experiences to Trainee need areas.

Consider graduate coursework, doctoral practicum and internship experience, and other didactic methods of training in gauging your training needs for your residency experience. Note that this does NOT impact your interview selection or placement in the residency program, but rather serves as a means to allow for training curriculum planning.

Please indicate your level of proficiency in the following areas using the rating rubric.

0 / No Training / No training or exposure in subject area
1 / Mildly Proficient / Minimal volume of coursework, training and experience in subject area
2 / Moderately Proficient / Some coursework, some training and some experience in subject area
3 / Highly Proficient / Considerable coursework, training or experience in subject area
Rating
(#) / Knowledge Base Area
Foundations for the Study of Brain-Behavior Relationships
Functional neuroanatomy
Neurological and related disorders, including etiology, pathology, course and treatment
Non-neurological conditions affecting CNS functioning
Neuroimaging and other neurodiagnostic techniques
Neuropsychology of behavior (e.g., psychopharmacology)
Foundations for the Practice of Neuropsychology
Specialized neuropsychological assessment techniques
Specialized neuropsychological intervention techniques
Research design and analysis in neuropsychology
Professional issues and ethics in neuropsychology
Practical implications of neuropsychological conditions

Last update, 1/9/14

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