Internship Program

Basic Program Information

* All questions listed in red must be completed to submit your program.

Institutional Affiliation:

Submitter Name:

Email Address:

Program Title:

Program City and State/Province

Department:








Program Director:

     Email:

     Phone:

     Fax:

     Address:

Program website:

Year program was originally established:

Accreditation (check all that apply):




(please specify)

Intensity of training experiences offered in clinical neuropsychology (check all that apply):




Member of Association for Internship Training in Clinical Neuropsychology (AITCN):

Stipend ($)/annum:

Total number of neuropsychology internship positions:

Number of neuropsychology supervisors:


Number of supervisors board certified in clinical neuropsychology:

Certifying Board(s):


Application and Admission Information:

Prerequisites for Admission:





List specific doctoral training experiences that are required for selection:

List specific doctoral training experiences that are preferred for selection:

Number of completed applications in the prior application cycle:

Number of applicants accepted into the program in the prior application cycle:

Number of positions anticipated for the upcoming year:

Application Deadline:

Month/Day program begins:


Training Experiences:

Overview

Overall percentage of time spent in neuropsychological clinical services (e.g., assessment, intervention, consultation, etc.)

percent

Overall percentage of time spent in other clinical services:

percent

Number of assessments/week:

Full
Brief

Overall percentage of time spent in research:

percent

Overall percentage of time spent in educational activities:

percent

Clinical Training

Specific Setting(s):

Other
 
 

Patient populations: Check if present, then enter maximum percentage of training with that population):







Please list the primary disorder(s) in your patient population in order of most frequent:

List intervention experiences offered:

Please list any additional information regarding your patient population (optional):

Didactics

Is there specialty coursework for neuropsychology interns (i.e., auditing or enrollment in a formal university course)?


If yes, please specify course (please put frequency in parenthesis after each)

Please list the rounds/seminars/conferences the neuropsychology resident is required to attend:

Type: (please put frequency in parenthesis after each)

Please specify other didactic training:

Type: (please put frequency in parenthesis after each)

Indicate if specific training/education is available for the following:





Is there training that specifically prepares interns for board certification?


Research

Please describe research opportunities at your site:

Do interns have access to research databases relevant to neuropsychology? If so, please explain.



Houston Conference Guidelines

Please respond to the following statements from Houston Conference Guidelines. (See www.theaacn.org/position_papers/houston_conference.pdf):

The training is completed in an APA or CPA approved program. The internship allows the completion of training in the general practice of professional psychology and extends specialty preparation in the science and professional practice of clinical neuropsychology.


Comment (optional):

Please add additional information to be included in your listing:


Please type 'div40' into the following text box to submit.