MARRIAGE AND FAMILY THERAPY PROGRAM Screened Program Course Application by bronbron

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									              MARRIAGE AND FAMILY THERAPY PROGRAM
                  Screened Program Course Application 2009-10

Marriage and Family Therapy (MFT) students submit only the registration form (over) with payment when
applying for a screened course. Nothing else is required. There are alternate starting dates for practica.
You can designate your preference for starting dates and indicate if you need a particular time of day
(morning, afternoon or evening), or would like to work with a particular supervisor. We can’t promise to
give you what you ask for but will consider your preferences when making assignments.

What the student does:

   q   The student completes the registration form and attaches a separate cheque in the amount of
       $100.00 for each course applied for, dated the first day of Regular student registration (ie. June
       29, 2009). Cheques are made payable to The University of Winnipeg. The student returns the
       form and the non-refundable deposit cheque(s) to Alys -Lynne Furgal, room 2S20, Sparling Hall.
       The remainder of the course fee is payable in the Graduate Studies office (1G03D) on the first day
       of the term in which the course is being offered.

   q   If requested, the student meets with the instructor of Self in the Family Laboratory or the Director
       of Training to assess readiness for the program requested.

   q   The student waits for a letter from the MFT Program Director within the time frame prescribed in
       the MFT program calendar, which is approximately six weeks after the close of applications.

What we do:

   q   We process screened program registrations within the schedule noted in the program calendar. All
       supervisors are involved in processing the applications.

   q   Letters are sent to each applicant communicating the outcome of the supervisors’ deliberations.
       We assume that those applicants who are given a place in a screened program will accept the
       assignment made.

   q   On the first day of Regular student registration, June 29, 2009, the $100 cheque(s) that you
       provided with your registration form is deposited. (The remainder of the course fee being payable
       in the Graduate Studies office (1G03D) on the first day of the term of the course being taken).

We do not provide refunds for screened courses, unless we can find another student to fill the space
assigned to you.




NOTE: To the individual who is NOT a regular or occasional student:

If you are not a regular or occasional student, contact the Director of Therapy for any additional
application materials that may be required.



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                                      The University of Winnipeg
                               MARRIAGE AND FAMILY THERAPY PROGRAM
                                            Screened Program Registration Form

Name(last/first): ____________________________ Previous Name (if applicable): _____________________________

Home Address: _______________________________________________ Postal Code: ________________________

City & Province: ________________________________________Fax Number: (____)__________________________

Phone (home): (_____)_________________ (work): (_____)_________________ (cell): (_____)__________________

Citizenship:     o Canadian             o Landed Immigrant              o International Student         Gender: o Female o Male

E-Mail: _______________________________________________ Birth Date (m/d/y): __________________________

CURRENT STUDENT CLASSIFICATION:(check one box) 1. REGULAR: o Master                                     o Certificate
2. o OCCASIONAL              3. OTHER: o Special         o Visitor

Have you been absent from The University of Winnipeg for more than three years? o YES              o NO
Note: If “yes”, you must submit an Application for Continuance for approval before your registration can be processed.

Which of the following core courses will you have completed by Sept? o Issues of Diversity in Family Therapy
o Survey of Family Therapy Theories o Couple Therapy o Self in the Family Laboratory o Plans and Interventions
o Abuse in the Family: Theory
 (CHECK) COURSE NUMBER                      ORDER                     COURSE TITLE                                  COURSE FEE
           MFT-7581/6                         1st         Supervised Marriage and Family Therapy                      $975.00
           MFT-7582/6                         2nd         Supervised Marriage and Family Therapy                      $975.00
           MFT-7583/6                         3rd         Supervised Marriage and Family Therapy                      $975.00
                     MFT-7584/6                 4th       Supervised Marriage and Family Therapy                        $975.00
                     MFT-7554/3                           Self in the Family Laboratory                                 $730.00
Note: All fees are 100% non-refundable

State practicum preferences re: start date, time of day, or Supervisor _________________________________________

________________________________________________________________________________________________

Are you applying to be an Intern-in-Training? o YES                   Are you applying to be a Resident-in-Training?           o YES

Are you applying for Master’s Student standing?           o YES
I hereby agree to honour all financial obligations in accordance with the policies of the University of Winnipeg, Faculty of Theology

_______________________________________________________                                     _________________________________
Student’s Signature                                                                         Date

ACCEPTANCE:
MFT-7554/3: I have reviewed this request and accepted the above named student into Self in the Family Laboratory.

Date __________________________Instructor’s Signature _______________________________________________

I have reviewed this request and accepted the above named student into a Practicum.

Date __________________________ Director of Training’s Signature ________________________________________

For Office Use Only: Receipt #:_____________ Date Entered:_________________ Initials: ____________
                                                           2 of 2                                          Revised Jan09

								
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