Checklist for Application for Clinical Training Program by 11yflme

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									         Checklist for Application for Clinical Training Program
                         in Forensic Psychiatry



Name:                                           Date:




                                                             Completed/Enclosed

1)   Application

2)   Copy of California Medical License (or statement
     affirming eligibility for license)

3)   Statement of Purpose

4)   Medical School Dean’s Report (give to Dean for direct
     mailing to Renée Binder, M.D.)

5)   Training Program’s Director’s Report (give to Program
     Director for direct mailing to Renée Binder, M.D.)

6)   Reference Letters from 3 supervisors (should be
     solicited by candidate and mailed directly to Renée
     Binder, M.D.)

7)   Curriculum Vitae

8)   Passport sized photo

9) Recent Work Products: TWO (2) general writing
samples which may include forensic reports or evaluations,
authored articles, papers, or patient evaluation/discharge
summaries

								
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