Research in Neuropsychoanalysis 2010-11
Form 1: Application Cover Sheet
Please compile into one single PDF the following:
1. this application cover sheet.
2. a copy of your CV.
3. a description of your research proposal, including a statement of hypothesis with brief
literature review, description of its neuroscientific and psychoanalytic relevance,
method/design, subject recruitment if appropriate, provisional budget and estimated
timeline. The maximum length of this section should be five pages.
4. a short description of your anticipated academic, clinical and research activities for the
upcoming year. This should include the percentage of your time dedicated to each,
specifying related income or additional sources of funding.
Send application by email to:
Ms. Aysegul Duru, Administrative Assistant, The Neuropsychoanalysis Foundation
38 East 63rd Street, New York, NY 10065, USA; email: email@example.com
Under separate cover, please send the signed mentor agreement (Form 2) and letters of
reference (Form 3) to the above address. (Either scanned copies by email, or hard copies by
mail, are acceptable.)
1. Applicant Information
Name of awarding institution:
Date of completion/graduation:
2. Supervising primary investigator/mentor
Institutional affiliation and contact information:
Please send agreement form signed by the primary investigator/mentor (Form 2)
under separate cover.
Please have two senior colleagues provide reference letters, which are to be sent directly to
the Neuropsychoanalysis Foundation (Form 3). Be sure to sign the waiver yourself at the
bottom of the form first.
Name and contact information for Referee 1:
Name and contact information for Referee 2:
COMPLETED APPLICATION IS DUE BY JANUARY 30, 2010