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Seminar Series Registration Form
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Name
*
Your answer
Email
*
Your answer
Are you a social worker, psychologist or psychoanalyst licensed in New York State.
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Choose
Yes, I am a Social Worker licensed in NYS
Yes, I am a Psychoanalyst licensed in NYS
Yes, I am a Psychologist licensed in NYS
None of these
City/State/Country of Residence
*
New York/NewYork/USA
Other:
Seminar Title
*
"Clinical Implications of the Shift to a Relational Perspective", Dr. Jody Davies
Semester
*
Spring 2024
How did you hear about the Mitchell Center Seminars:
*
Mitchell Center Listserv/Email
ICP Listserve
IARPP Listserve
NYU Post Doc Listserve
WAWI Listserv
Mitchell Center Website
Friend/colleague
Other:
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Have you attended other Mitchell Center seminars?
*
Yes
No
Have you attended any Mitchell Center full-year trainings?
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Yes
No
Highest degree earned:
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MA
MSW
Doctorate
MD
Psychoanalytic training:
*
Yes
No
Psychodynamic training
If yes, what institute, program name, and date of completion:
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Your answer
Licensed to practice independently?
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Yes
No
If you have any other info you'd like to share, you can do so in the text field below, and then hit Submit.
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