Internship Application

MASSACHUSETTS MENTAL HEALTH CENTER

Department of Psychiatry
Harvard Medical School
180 Morton Street

Jamaica Plain, MA 02130

SUPPLEMENTAL APPLICATION FOR
PREDOCTORAL INTERNSHIP IN CLINICAL PSYCHOLOGY

Applicant Code Number __________

Name___________________________________

Social Sec. #_____________________

Address_________________________________________________________

Home Phone_____________________

University Phone__________________

E-mail__________________________________________________________

1. Please forward your c.v.

2. Include a sample of your written
clinical work (e.g. case write-up, test report).

3. Please submit an autobiography.
Do not substitute a history of your professional development for a personal
history. If your

    APPIC autobiography
is a personal history, no additional submission is required.

4. Three letters of recommendation should be submitted, either directly or together with your application.

5. Transcripts of undergraduate and graduate work must be provided.

6. Please indicate all dates you could come for interview, and preference.

    Dec 18____
Jan 8____ Jan 22____

7. Applications cannot be reviewed until all required materials are received.

Send application and supporting materials
to:

June G. Wolf, Ph.D.
Director of Psychology
Massachusetts Mental Health Center
180 Morton Street

Jamaica Plain, MA 02130

Deadline for receipt of all materials is November
6, 2006.