GW Postdoctoral Fellowship Application Instructions
Thank you for your interest in working with the George Washington University’s Counseling Center, Mental Health Services, for your postdoctoral fellowship. In order to be considered for the fellowship, please be sure you have included all of the following materials:
☐ / Curriculum Vitae (CV)☐ / Cover Letter
☐ / Completed Application (pages 2-6 below) – Complete this application electronically, save to your personal computer and attach the file in an email.
☐ / Letter from Academic Advisor – This letter, on official letterhead, should verify that you will graduate in good standing on or before 7/31/17.
Your application is not considered complete in the absence of any one of the above components.
In one email, please send all of the above materials to Dr. Amber Cargill, Training Director, at . In the subject line, please include your first and last name, as well as an indication that it is the completed postdoctoral fellowship application. Once you have sent it there it will be received and reviewed by the hiring committee, but because of the volume of applicants, you will not be able to get an update on your status following application submittal.
Should you have any technical issues with the application, please do not hesitate to get in touch with Kaithlyn Kayer, HR Client Partner, at .
Thank you again for your interest in working with Mental Health Services, the University Counseling Center at the George Washington University!
GW Postgraduate Fellow Application
Please fill in all fields electronically as prompted below. This file can be saved to your personal computer and attached in an email when completed.
CONTACT INFORMATIONFirst Name / Click here to enter text. / Home Phone / Click here to enter text. /
Last Name / Click here to enter text. / Work Phone / Click here to enter text. /
Street Address / Click here to enter text. / Cell Phone / Click here to enter text. /
Apartment / Click here to enter text. / Preferred Phone / Choose from list. /
City / Click here to enter text. / Primary Email / Click here to enter text. /
State / Click here to enter text. / Secondary Email / Click here to enter text. /
Country / Click here to enter text. /
Zip Code / Click here to enter text. /
PERSONAL INFORMATION
Citizenship Status / Choose from list. / Do you hold a Visa? / Yes or No. /
Country of Citizenship / Click here to enter text. / Visa Type / Click here to enter text. /
Other Citizenship / Click here to enter text. / Visa Number / Click here to enter text. /
City of Visa Issue / Click here to enter text. /
Visa Current and Valid? / Yes or No. /
Veteran? / Yes or No. / Visa Permits Work? / Yes or No. /
GENERAL
Preferred Name or Nickname / Click here to enter text. /
Do you have materials under another name? / Yes or No. /
If yes, specify other names used / Click here to enter text. /
Language(s) other than English (including American Sign Language) in which you are fluent enough to conduct therapy / Click here to enter text. /
CERTIFICATIONS
Enter the name of License 1. / Enter the name of Jurisdiction 1. /
Enter the name of License 2. / Enter the name of Jurisdiction 2. /
Enter the name of License 3. / Enter the name of Jurisdiction 3. /
Enter the name of License 4. / Enter the name of Jurisdiction 4. /
PROFESSIONAL CONDUCT
Has disciplinary action, in writing, of any sort ever been taken against you by a supervisor, educational or training institution, health care institution, professional association, or licensing/certification board? / Yes or No. /
If ‘Yes,’ please elaborate: Click here to enter text.
Are there any complaints currently pending against you before any of the above bodies? / Yes or No. /
If ‘Yes,’ please elaborate: Click here to enter text.
Has there ever been a decision in a civil suit rendered against you relative to your professional work, or is any such action pending? / Yes or No. /
If ‘Yes,’ please elaborate: Click here to enter text.
Have you ever been put on probation, suspended, terminated or asked to resign by a graduate or internship training program, practicum site or employer? / Yes or No. /
If ‘Yes,’ please elaborate: Click here to enter text.
Have you ever been convicted of an offense against the law other than a minor offense against the law other than a minor traffic violation? / Yes or No. /
If ‘Yes,’ please elaborate: Click here to enter text.
Have you ever been convicted of a felony? / Yes or No. /
If ‘Yes,’ please elaborate: Click here to enter text.
Will you graduate from your current graduate program on or before 7/31/17 in good academic standing? / Yes or No. /
If ‘No,’ please elaborate: Click here to enter text.
EDUCATION – CURRENT INSTITUTION
Institution Name / Click here to enter text. /
Department / Click here to enter text. /
Program Name / Click here to enter text. /
College Name / Click here to enter text. /
Degree Seeking / Click here to enter text. /
GPA / Click here to enter text. /
Accreditation Status / Choose from list. /
EDUCATION – PRIOR INSTITUTION
Institution Name / Click here to enter text. /
Type / Choose from list. /
Major / Click here to enter text. /
Minor/Second Major / Click here to enter text. /
Degree Pursued / Click here to enter text. /
Degree Status / Choose from list. /
Degree Date / Click here to enter text. /
GPA / Click here to enter text. /
EDUCATION – PRIOR INSTITUTION (leave blank if no additional institution to mention)
Institution Name / Click here to enter text. /
Type / Choose from list. /
Major / Click here to enter text. /
Minor/Second Major / Click here to enter text. /
Degree Pursued / Click here to enter text. /
Degree Status / Choose from list. /
Degree Date / Click here to enter text. /
GPA / Click here to enter text. /
INTERVENTION EXPERIENCE – Check the boxes to indicate if you have experience in the below areas and be sure to highlight endorsed experiences in your CV.
Individual Therapy / Career Counseling
Adults (25-64) / ☐ / Adults / ☐ /
College Aged Adults (18-25) / ☐ / Adolescents (13-17) / ☐ /
Adolescents (13-17) / ☐ /
Family Therapy / Group Counseling
Family Therapy / ☐ / Adults / ☐ /
Other Psychological Interventions / Adolescents (13-17) / ☐ /
Intake Interview/Structured Interview / ☐ / Couples Therapy
Substance Abuse Interventions / ☐ / Couples Therapy / ☐ /
Eating Disorders / ☐ / Other Psychological Interventions
Multicultural/International Students / ☐ / Trauma Interventions / ☐ /
Veterans / ☐ / Sport Psychology/Performance Enhancement / ☐ /
Outreach/Consultation / ☐ /
Supervision / ☐ /
ADDITIONAL INFORMATION ABOUT PRACTICUM EXPERIENCE – Check the boxes to indicate if you have experience in the below areas and be sure to highlight endorsed experiences in your CV.
Child Guidance Clinic / ☐ / Private Practice / ☐
Community Mental Health Center / ☐ / Residential/Group Home / ☐
Department Clinic / ☐ / Schools (K-12) / ☐ /
Forensic/Justice Setting / ☐ / University Counseling Center/Student Mental Health Center / ☐
Inpatient Psychiatric Hospital / ☐ / VA Medical Center / ☐ /
Medical Clinic/Hospital / ☐ /
Outpatient Psychiatric Clinic/Hospital / ☐ /
Partial Hospitalization/Intensive Outpatient Programs / ☐ /
Other practicum experience? / Click here to enter text. /
ANTICIPATED EXPERIENCE
Description of anticipated experience between application date and 7/31/17. Please highlight experience in any specialty or other relevant area. Write “N/A” if no additional experience expected. / Click here to enter text. /
References
A Professional Reference should be provided by a connection who can attest to your overall employment, conduct, character, working skill, knowledge and clinical capabilities.
A minimum of 3 Professional References are required. We will not contact your references before letting you know that we are planning to do so.
Name of Reference / Click here to enter text. /
Relationship / Click here to enter text. /
Contact Number / Click here to enter text. /
Contact Email Address / Click here to enter text. /
Years Known / Click here to enter text. /
REFERENCE 2
Name of Reference / Click here to enter text. /
Relationship / Click here to enter text. /
Contact Number / Click here to enter text. /
Contact Email Address / Click here to enter text. /
Years Known / Click here to enter text. /
REFERENCE 3
Name of Reference / Click here to enter text. /
Relationship / Click here to enter text. /
Contact Number / Click here to enter text. /
Contact Email Address / Click here to enter text. /
Years Known / Click here to enter text. /
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