UNIVERSITY OF COLORADO AT DENVER AND HEALTH SCIENCES CENTER
Division of Psychology	4200 East Ninth Avenue
Box C-258-48, UCD&HSC	Denver, Colorado  80262

SUPPLEMENTAL APPLICATION FOR PREDOCTORAL  PSYCHOLOGY INTERNSHIP
2007-2008 TRAINING YEAR

Please complete this supplemental application in addition to the APPIC Application for Psychology Internship.
Personal Data:
Name	
Address	
City: 	  	State: 	  	Zip Code: 	
Ethnic Origin (optional) : 		  Applicant Code Number:  	
Please Note:  Read the current brochure carefully before completing this application.  Supplemental information may be appended to this application.  But you must provide the data requested in the space provided below. For updated information about the internship, contact our website at www.uchsc.edu/sm/psych/divpsy 

Applying for (check one):	APPIC Program 
	Code Number

1. American Indian-Alaska Native Track			__________	(117516)

2. Denver Children's Home Track				__________	(117518)

3. Department of Corrections Track			__________	(117514)

4. JFK Partners Deaf Link Track				__________	(117513)

5. JFK Partners Developmental Disabilities 
            Track					__________	(117512)

6. Primary Care Psychology Track			__________	(117519)



1. What characteristics of the supervisor and the trainee-supervisor relationship enhance or detract from your learning?  Do not exceed 200 words.












2. Cite one book or journal article in the psychological literature that has had an impact on your development as a psychologist.  Briefly explain why this book or article was meaningful to you. Do not exceed 200 words.












3.  Briefly describe a treatment failure.  How did you contribute to this failure? What you did you learn about yourself and how to do therapy from this experience?  How did your clinical work change because of this experience?  The patient should be representative of your experience which is relevant to the track for which you are applying.. Do not exceed 500 words.











Note:

A completed application consists of (a) the APPI 2006 completed by the candidate; (b) the University of Colorado Health Sciences Center Division of Psychology Supplemental Application Form (c) curriculum vitae; (d) official graduate school transcript(s); (e) the “Academic Program’s Verification of Internship Eligibility and Readiness” from the AAPI 2006 sent directly to us at the address below with your training director’s signature across the seal of the envelope; and (f) three letters of recommendation.  It is the candidate's responsibility to see that all application materials are received by November 18, 2006.  If you mail a pre-addressed, stamped postcard, we will return it when your application is complete.  Address all application materials to:

	Hal C. Lewis, Ph.D.
	Director of Psychology Training
	Box C-258-48
	University of Colorado Health Sciences Center
	4200 East Ninth Avenue
	Denver, Colorado  80262.


If you have any questions regarding completion of this application, please contact Ms. Brenda Martin at (303) 315-2510 or Fax (303) 315-2527 or e-mail  Brenda.Martin@UCHSC.edu.



__________________________________________________________________
	(Your Signature)						(Date)