Coloring Psychoanalysis Interest Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

First Name *

Last Name *

Preferred Name

Email Address *

I am a(n)...(check all that apply)

Undergraduate student

Graduate student

Pre-licensure professional (e.g., post-doc, AMFT, medical resident, etc.)

Licensed mental health professional

Psychoanalyst

Academic professional (e.g., researcher, professor, etc.)

Other:

Optional: tell us a little about why you're interested in Coloring Psychoanalysis, and/or what do you hope to see?

Confirm your interest: *

Yes, please keep me posted about the first issue of Coloring Psychoanalysis!

Required

Identification and intention of BIPOC-centered space: *

I self-identify as BIPOC (Black, Indigenous, and People of Color) and understand that the intention of this space is to foster psychoanalytically-oriented dialogue by and for BIPOC; if you are an ally seeking content about BIPOC psychoanalysis, we encourage you to seek out alternate spaces to develop your allyship, and/or take another of our suggested actions for support.

Required

Thank you for your interest, and welcome to the Coloring Psychoanalysis community! We will be touch shortly. If you have any questions, please email us at coloring.psychoanalysis@gmail.com.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms