COUNCIL OF CLINICAL HEALTH PSYCHOLOGY TRAINING PROGRAMS (CCHPTP)

Membership Application

Name of Program:______

University or Training Site: ______

Type of Training Program: □ Doctoral □ Internship □ Post-doctoral

Name and Mailing Address of Training Director:

______

______

______

E-mail address of Training Director: ______

Phone number of Training Director: ______

WEB address of Program: ______

Qualifications

Members of CCHPTP are clinical health psychology doctoral, internship, and post-doctoral programs that produce clinical health psychologists capable of functioning as scientific investigatorsand as practitioners, consistent with the highest standards of clinical health psychology. CCHPTP members adhere to a scientist-practitioner, clinical scientist, or related training model in which all trainees obtain competencies in both conducting empirical research and engaging in practice in clinical health psychology settings.

CCHPTP has two types of membership:

1)Full Membership is offered to well established programs that adhere to a scientist-practitioner or related model and have produced students with competency in clinical health psychology. Program representatives from programs with Full Membership can participate in all aspects of CCHPTP governance, including running for elected office, voting for candidates for office, and voting on initiatives being considered by the organization.

2)Associate Membership is offered to recently established programs that adhere to a scientist-practitioner or related model but have not yet produced students with competency in clinical health psychology. Representatives of programs with Associate Membership are welcomed and encouraged to participate in discussion of initiatives being considered by CCHPTP, but cannot participate in CCHPTP governance. CCHPTP expects that Associate Member programs will achieve Full Membership status once they have produced program “graduates.”

Describe your model of training and explain how it assures that all trainees obtain competencies in both conducting empirical research and engaging in practice in clinical health psychology settings:

Doctoral Program members of CCHPTP are training programs from regionally accredited, comprehensive universities. For doctoral training program applicants, name the regional accrediting body for your university: ______

Is your program accredited by the American Psychological Association or the Canadian Psychological Association? ____yes ______no

Program Data

1.In what year, did the first clinical health psychology trainee complete your program? _____

2.How many clinical health psychology trainees completed your program in the last calendar year? ______

3.How many clinical health psychology trainees completed your program in the last 5 calendar years? ______

  1. How many of these trainees completed an empirical research experience (e.g., thesis, dissertation) as part of their training? ______
  2. How many of these trainees completed a clinical applied experience in a clinical health psychology setting (e.g., practica, internship) as part of their training? ______

4.How many clinical health psychology trainees are currently in your program? ______

  1. How many trainees published at least one article in a peer-reviewed journal in the past year? ______
  2. How many trainees engaged in practicum in a clinical health psychology setting during the past year? ______

5.How many full-time faculty members are currently providing health psychology training to trainees in your training program? ______.

Please list health psychology faculty members by name:

Of these faculty members:

  1. How many full-time faculty members published at least one article in a peer-reviewed journal in the past year? ______
  2. How many full-time faculty members collaborate in research with colleagues from other health care professions? ______
  3. How many full-time faculty members funded their research program through external grants during the past year? ______
  4. How many full-time faculty members supervised practicum experiences for trainees in clinical health psychology settings during the past year? ______

Additional Information

Please submit the following pieces of additional information:

1.A letter of support from the chairperson/head of your Department/Section attesting to the fact that the clinical health psychology program is an integral part of the Department/Section and that the Department/Section will support membership in CCHPTP by sending the training director to meetings and by paying annual dues.

2.A copy of the vita of the current clinical health psychology program training director.

3.Copies of any brochures or related materials that describe your training program (e.g., to potential graduate students, site visitors, etc…)

Please return this application to the Secretary-Treasurer of CCHPTP(electronic copies preferred):

Sharon Berry, Ph.D., Secretary/Treasurer

Psychology, 17-217, 2525 Chicago Avenue South

Minneapolis, MN 55404

Phone: (612) 813-6727

Email:

Revised 2/15/11