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Application for Associate Membership

We are pleased that you are considering applying for membership.  The Membership Committee may, at its discretion, direct inquiries to supervisors and institutes noted in the application.  If you have graduated from an organized training program which does not fully meet the recommended guidelines, the Membership Committee will consider any post-graduation training experiences such as seminars and private supervision.  These should be documented in the application.  For those not trained in organized training programs, all psychoanalytic training experiences should be documented.



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Personal Information

Graduate Education
Type "N/A" if not applicable
Graduate School / Medical School:
Name of Graduate School / Medical School
Graduation Year


Psychiatric Residency / Clinical Internships:
Name of Psychiatric Residency / Clinical Internships
Graduation Year


Other Graduate Training:
Name of other Graduate Training Institutions
Graduation Year


Other Professional License:
Post-Graduation Training Experiences

Psychoanalytic Activity
Type "N/A" if not applicable

Ethical Disclaimer

The San Francisco Center for Psychoanalysis (SFCP) adheres to the Principles and Standards of Ethics for Psychoanalysts of the American Psychoanalytic Association (“APsaA”) and the Guidelines of the Ethics & Impairment Committee of SFCP.

  1. I confirm that I have been provided access to these documents (hard copies are available upon request), have been advised to read them, and agree to abide by them.
  2. As part of the application process, I give permission to SFCP to make inquiry for purposes of verification to the various professional organizations and licensing boards holding information pertinent to my professional qualifications, competence, or history of conduct as a professional. I understand that this inquiry will be performed in good faith by the SFCP committee responsible for the consideration of this application in consultation with the co-chairs of the SFCP Ethics and Impairment Committee. (For example, inquiry about status of your license, information from that licensing agency that is part of the public record, or inquiry to verify your faculty status at another professional organization).

I hereby certify that to my knowledge:

Yes No

Electronic Signature
By entering your name below, you acknowledge that all of the above information is true and accurate to the best of our knowledge.  Electronic submission of this form is equivalent to your handwritten signature
Your Name
Today's Date

San Francisco Center for Psychoanalysis
444 Natoma Street
San Francisco, CA 94103
T: (415) 563-5815
E: office@sfcp.org