Division 40 of the American Psychological Association

Postdoctoral Residency Program

Submitter Name:^*required

Email Address:^*required

Program Title:^*required

Program City/State:^*required

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:

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:

Length of Program (years):

Specific Setting(s):	Academic Medical	Psychiatric Hospital
	General Hospital	Outpatient or private setting
	VA Hospital	Other
	Rehab Hospital

Patient Population:

Adult
Child

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):

Number of Assessments/week:

Full
Brief

Percent time/week in clinical research:

Percent time/week in educational activities:

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:

Please type 'div40' into the following text box to submit.