Application Name Applying For Please mark which training program you are interested in * Family Therapy Training Program Clinical Externship Student Practicum Pinat HaYeled Unit Trauma Unit Child Sexual Abuse Unit Adolescent Unit Couple's Unit Personal Information First Name * Last Name * Address * City * Country * Home Phone * Cell Phone * Email Address * Age * Marital Status * Number of Children * Education Highest Degree Achieved Field of Study Institution Completion Date Please indicate below those courses of study that you have completed and/or attended that are relevant to your preparation as an intern/student at The Family Institute of Neve Yerushalayim: Institution Institution Institution Country Country Country From - To From - To From - To Completion Date Completion Date Completion Date Have you completed the following courses or their equivalent on a Graduate level? Psychopathology * YesNo Human Development/Life Cycle * YesNo Family Systems/Family Therapy * YesNo Couples Therapy * YesNo Clinical Experience Do you have at least one year of supervised clinical experience in either an internship/practicum or similar framework? * 1 Year2 Years3 YearsNo Experience Language Competency English Speak Fluently Speak Moderately Speak Poorly Comprehend Only Hebrew Speak Fluently Speak Moderately Speak Poorly Comprehend Only Russian Speak Fluently Speak Moderately Speak Poorly Comprehend Only Yiddish Speak Fluently Speak Moderately Speak Poorly Comprehend Only Spanish Speak Fluently Speak Moderately Speak Poorly Comprehend Only Other Speak Fluently Speak Moderately Speak Poorly Comprehend Only Other In order to process your application and arrange an interview, please be sure to email the following to nevefamilyinstitute@gmail.com Please check off each one that you have emailed * Teudat Yosher (available at your local police station) Letter of recommendation or evaluation from previous clinical supervisor Transcripts of Graduate level courses Current resume Recent passport photograph The application fee of 150 NIS payable to Neve Yerushalayim can be paid by cash or credit card by calling 02-654-4600 or visiting our office at 1 Beit Yitzchak Street, Har Nof Questions and Comments How did you hear about The Family Institute? *Subject to Change Please do NOT close this page until you see a confirmation page that your application has been received.
