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Alfred Adler Fellows Application
Please fill out all the required fields and submit before May 31, 2023
* Indicates required question
Email
*
Your email
Name
*
Your answer
Email
*
Your answer
Home Address
*
Your answer
Age
*
Your answer
Have you completed a Masters or Doctoral degree in the mental health field? (E.g., MA/M.Ed. in Counseling, MSW, MS/PhD/PsyD in Clinical Psychology, etc.)
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Yes
No
Do you hold a license to practice in the mental health field? (Provisional licenses like LPC-A are acceptable)
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Yes
No
In what setting do you currently work?
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Inpatient treatment center
Residential treatment center
Outpatient Community Mental Health Agency
Private Practice
Other:
What is your interest in the Alfred Adler Fellows Program (AAFP)?
*
Your answer
What do you hope to gain from participating in AAFP?
*
Your answer
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