Home: Health Professionals: Departments/Services: Psychology: Training: Internship Application Form

Psychology : Internship Application Form

Name
Match ID Number
Date
Canadian Citizen?	Yes No
If not a Canadian Citizen, what is your status?
Telephone on Match Day
Email Address (work)
Email Address (home)

University / Work Address	Home Address

University / Work Telephone	Home Telephone

Please indicate your preferred mailing address
Work/School		Home

Languages	Written	Level of Competence	Spoken	Level of Compentence
English
French
Other

Tracks: Check the Track(s) to which you are applying. You may apply to more than one track (APPIC number). A separate and complete application package must be submitted for each of the Tracks (APPIC numbers) to which you are applying.

	Track 1: Mental Health – Rehabilitation Psychology
	Track 2: Health Psychology – Rehabilitation Psychology
	Track 3: Neuropsychology

Services Within Tracks - Rank your preferred services.

Rehabilitation Psychology (Applicants to Tracks 1 and 2)
Rehabilitation Psychology is organized into three Patient Care streams with services within each stream.

	Locomotor
	Neuromuscular
	Neurocognitive

Neuropsychology (Applicants to Track 3)
By applying to this track, you are requesting to spend a major rotation (nine months) in clinical neuropsychology. You must also choose a second minor rotation (3 months) from the following:

	Mental Health
	Health Psychology

Please Rank Order These Possible Interview Dates

	January 5, 2009
	January 9, 2009
	January 12, 2009
	January 16, 2009

Additional information needed to complete your application

Official transcripts of your undergraduate and graduate academic record.
A curriculum vitae.
An APPIC Verification Form completed by the Director of your clinical graduate program attesting to your status in your program and the Department's agreement to the proposed placement.
Letters of recommendation from at least three individuals familiar with your work. Please list below the names, positions, addresses, and telephone numbers of the three individuals from whom you have requested references in the box below.

The APPIC Application form, which is available at http://www.appic.org/
You must register with the National Matching Services, http://www.natmatch.com/psychint/ , and/or APPIC http://www.appic.org and put your Match ID Number at the top of this Application form.

The Ottawa Hospital is committed to the principles of Employment Equity and welcomes applications from all qualified candidates. Women, people of aboriginal descent, members of visible minorities, and people with disabilities are invited to identify themselves as members of these groups, if they wish, by checking the box and indicating to which group they belong.

Please return application and supporting documents before November 14, 2008 to:

Dr. Laura Rees & Dr. Kerri Ritchie
Co-directors of Training
Department of Psychology
The Ottawa Hospital
501 Smyth Rd, Suite 7300
Ottawa, ON
K1H 8L6
Tel: 613-737-8039
Fax: 613-737-8895
Email: psychology@ottawahospital.on.ca

A copy of your completed application form will be emailed to you.