<p> ASSOCIATION OF JUNGIAN ANALYSTS</p><p>A Jungian Analytic Training for Qualified Psychotherapists</p><p>Application Form</p><p>Applications are invited, and will be processed from 1st June 2016. Please return your completed application to Helena Rogowska at [email protected]. The deadline for applications is the 31 May 2016. Please post a cheque separately to AJA for £200 made out to Association of Jungian Analysts, which is a charge for processing your application.</p><p>Please include copies of relevant certificates, professional memberships and professional indemnity with your application.</p><p>1. Name, address, telephone numbers, email address.</p><p>2. Academic qualifications, with dates.</p><p>3. Details of psychotherapy training, qualifications, and membership(s) of psychotherapy organisation(s).</p><p>4. Details of psychiatric clinical placement or other hospital experience.</p><p>5. Post-graduate training, including details of psychotherapy courses, before and/or after qualification, with dates.</p><p>6. Details of all previous psychotherapy/analysis, with names of therapists/analysts (with their affiliations), dates, numbers of hours, and frequency.</p><p>7. Details of all previous supervision, individual and/or group, with names (and affiliations), dates, numbers of hours, and frequency.</p><p>8. Details of all previous clinical work, with numbers of hours, and frequency at which worked.</p><p>9. Details of all Jungian courses and seminars attended, including during training.</p><p>Association of Jungian Analysts - 7 Eton Avenue, London NW3 3EL - Tel/Fax: 020 7794 8711 – Email: [email protected] www.jungiananalysts.co.uk Registered Charity No. 274 466 ~ Company limited by guarantee Reg No 132 8178 Continue</p><p>10. Details of any significant physical or psychological medical conditions, past or current.</p><p>11. Details of any complaints made against you during the course of your professional work.</p><p>12. Personal Biography. Write a reflection on significant experiences in your life which have influenced you and led you to this point. (maximum 1000 words). </p><p>13. Write a statement on why you want to become a Jungian analyst? (maximum 500 words)</p><p>Include the following:-</p><p>What it is about the Jungian approach that attracts and interests you? What do you hope to gain from participating in the course and from your subsequent membership of AJA. </p><p>14. Names and addresses of two referees, both of whom have knowledge of your work as a psychotherapist. References will be sought after the initial screening of your application.</p><p>May 2015.</p><p>Association of Jungian Analysts - 7 Eton Avenue, London NW3 3EL - Tel/Fax: 020 7794 8711 – Email: [email protected] www.jungiananalysts.co.uk Registered Charity No. 274 466 ~ Company limited by guarantee Reg No 132 8178</p>