Postdoctoral Residency Program Submitter Name:*required           Email Address:*required Program Title:*required Program City/State:*required Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Please fill out the questions below as relates to your program: Department: Psychiatry Neurology Psychology Rehabilitation Free Standing Pediatrics Other Program Director:   Email:   Phone:   Fax:   Address: Program website: Number of completed applications in the preceding year: Number of applicants accepted into the program in the preceding year: Number of positions anticipated for the upcoming year: Application Deadline: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Accreditation in neuropsychology by APA: Yes No Member of Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN): Yes No Participate in APPCN Match Program: Yes No Total number of neuropsychology resident positions: Full-Time Faculty Number: Number of Faculty Board Certified: Certifying Board(s): Prerequisites for Admission: None Only APA/CPA-accredited doctoral program Only APA/CPA-accredited internships Is there specialty coursework for neuropsychology residents? Yes No If yes, please specify course (please put frequency in parenthesis after each) Please list the rounds/seminars/conferences the neuropsychology resident is required to attend: Type: (please put frequency in parenthesis after each) Please specify other didactic training: Type: (please put frequency in parenthesis after each) Indicate if specific training/education is available for the following: Functional Neuroanatomy Disorders Affecting the Nervous System Neurodiagnostic Techniques Neuropsychologic Interventions Stipend ($)/annum: Year One      Year Two Month/Day program begins: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Length of Program (years): one two three Specific Setting(s): Academic Medical Psychiatric Hospital   General Hospital Outpatient or private setting   VA Hospital Other   Rehab Hospital   Patient Population: Adult 0-10% 11-20% 21-30% 31-40% 41-50% 51-60% 61-70% 71-80% 81-90% 91-100% Child 0-10% 11-20% 21-30% 31-40% 41-50% 51-60% 61-70% 71-80% 81-90% 91-100% Please list the primary disorder(s) in your patient population in order of most frequent: List the current research projects of the faculty and residents (indicate if funded): Percent time/week in clinical service (assessment, intervention, consultation): Select One under 25% 26-32% 33-49% 50-70% 71-90% Over 90% Number of Assessments/week: Full   Brief Percent time/week in clinical research: 0-10% 11-20% 21-30% 31-40% 41-50% 51-60% 61-70% 71-80% 81-90% 91-100% Percent time/week in educational activities: 0-10% 11-20% 21-30% 31-40% 41-50% 51-60% 61-70% 71-80% 81-90% 91-100% List types of clinical experience in the program: Identify the exit criteria for the residency: Capable of independent practice in: Assessment Scholarly activity submitted for publication,      presentation, or grant proposal   Intervention Advanced knowledge of brain-behavior relations   Consultation Other Is there an exit exam: Yes No Please add additional information to be included in your listing: