Name of of Applicant *
Contact numbers *
Your email *
Interviewer Name *
How did they hear about NJI: *
Interest in Psychoanalytic training: *
Educational background: *
Employment History: *
Current employment: *
Clinical experience: *
Personal Analysis: *
Program of interest: *
Part time or full time? : *
Requirements of program explained: *
Semester of interest/Classes begin: *
Received class schedule, course descriptions and explanation of PACO membership *
Low fee supervision list given (optional for 1 yr program) *
Registration instructions given: (mail in copy and/or how to register online – www.njinstitute.com,, under Registration tab, Courses) *
Fall Semester Tuition: $350.00 per class plus $115 semester registration fee that includes PEP WEB library (for one year - paid in the FALL) and PACO membership (for one year -paid in the FALL)
Spring Semester Tuition: (for returning candidates) $350.00 per class plus $85 semester register fee that includes the graduation luncheon held in May.
Spring Semester Tuition: (for New candidates) $350.00 per class plus $155.00 semester fees that included PEP Web library, PACO membership and graduation luncheon held in May.
Tuition is due before class begins.(Fall semester by Sept. 1st; Spring semester by Feb. 1st)
If you need a monthly payment program, contact Jan Alderisio at email@example.com)
Refund policy: Half of the tuition will be refunded if less than four classes are taken. After four classes, there will be no refund; credit will remain on the account until candidate returns to the Institute.
The Candidate is in agreement with the above information. The Candidate understands that a requirement of admission is to submit an original graduate transcript, either electronically or by mail. A copy of your resume and credential(s) are also needed. The Candidate will be notified by mail of their acceptance to NJI for Training in Psychoanalysis and we will provide a candidate handbook at the time.
Candidate signature: *
Interviewer signature: *