Application – The Family Institute

Please mark which training program you are interested in:*

Clinical Internship
Externship
Student Practicum

First Name*

Middle Name

Last Name*

Teudat Zehut or Passport #*

Phone Number*

E-mail

Language Competency

How well do you speak the following languages?

English*

Hebrew*

French*

Russian*

Yiddish*

Other?

Education

Highest Degree Achieved*

Field of Study*

Institution*

Date completed*

Please indicate below those courses of study that you have completed and/or attended that are relevent to your preparation as an intern/student at the Family Institute of Neve Yerushalayim.

Institution and Country

Degree Received

Field of Study

From - To

Institution and Country

Degree Received

Field of Study

From - To

Institution and Country

Degree Received

Field of Study

From - To

Have you completed the following courses or their equivalent on a graduate level?

Psychopathology*

Institute attended*

Number of Hours/Grade*

Date Completed*

Human Development/Life Cycle*

Institute attended*

Number of Hours/Grade*

Date Completed*

Family Systems/Family Therapy*

Institute attended*

Number of Hours/Grade*

Date Completed*

Couples Therapy*

Institute attended*

Number of Hours/Grade*

Date Completed*

Do you have at least one year of supervised clinical experience in either an internship/practicum or similar practice framework?*

Yes
No

Briefly describe the nature of your clinical experience to this point:

Organization or Agency

Name of Supervisor

Date of Clinical Experience

Brief description of clinical experience, caseload, populations, issues.

Organization or Agency

Name of Supervisor

Date of Clinical Experience

Brief description of clinical experience, caseload, populations, issues.

Organization or Agency

Name of Supervisor

Date of Clinical Experience

Brief description of clinical experience, caseload, populations, issues.

The caseload responsibilities for full time interns require an average of 4 to 6 client contact hours per week at The Family Institute of Neve Yerushalayim. In addition, interns will receive 1 hour of individual supervision, 2 hours of group supervision and 2 hours of Professional Development Program totaling approximately 12 hours per week. At least one afternoon/evening of client contact is required of therapists. Moderate level of Hebrew language fluency is necessary in order to complete 350 hours within 2 years.

Are you prepared to make this time commitment?

Yes
No

In order to process your application and arrange an interview please make sure to send us the following by email or fax. Email: dmendlowitz@nevey.org or Fax: 02-627-4190*

Passport Photo
Resume
Letter of recommendation or evaluation from most recent clinical supervisor
Teudat Yosher (available at your local police station)
Transcripts of graduate level courses
Application fee of 150 NIS made payable to Neve Yerushalayim

Comments*

Intern Application