* indicates required fields. Please complete the form below and then click the submit button at the bottom. On the next webpage you will be able to upload an abbreviated CV of five pages or less. The abbreviated CV may contain only highlights and does not need to be a complete version.
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General Information
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First Name:*
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Last Name:*
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Affiliation:*
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Address 1:*
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Address 2:
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City:*
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State:*
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Zip:*
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Country:*
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Daytime Phone:*
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Alternate Phone:
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FAX:
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Email:*
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Position Title OR
date of expected doctoral degree
(if student):*
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Department Name:
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APA Member:*
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Yes
No
I am applying for membership now.*
*You must submit your APA membership or affiliate application at the same time that you submit your ATI application. Discounted tuition will not be given for APA membership/affiliate applications submitted after the ATI application deadline. In addition to submitting the APA application online, a copy of your submitted membership application must be faxed to Attn: Advanced Training Institute at 202-336-5953 or emailed to ATI. The APA membership form is available on-line.
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Gender:
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Male
Female
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Are you Spanish / Hispanic / Latino(a)? (Select the appropriate
group(s).)
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No, not Spanish/Hispanic/Latino(a)
Yes, Cuban
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, South/Central American
Yes, Other Spanish/Hispanic/Latino(a)
please specify:
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What is your race / ethnic heritage? (Please select all that apply.)
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Caucasian/White
African American/Black
American Indian or Alaskan Native
please specify name of enrolled or principal tribe:
East Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
please specify:
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
please specify:
Some Other Race
please specify:
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How did you learn about this ATI? (please indicate all that apply)
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APA Psychological Science Agenda
APA Monitor on Psychology
Other Publication, which?
APA/ATI website
Other website, which?
Internet search
Listserv Announcement, which?
Department Announcement
From a past ATI participant
From one of my professors
From one of my faculty colleagues
Other, please explain:
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Personal Statement
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1. Briefly state why you would like to attend this ATI. (Selection criteria are here. Please limit response to 300 words.)*
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2. How will you use the knowledge gained in this ATI in future research? (Please limit response to 300 words.)*
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* indicates required fields.
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