MT Fellowship + Postdoctoral Residency Form

We appreciate your interest in this truly unique position and opportunity for extraordinary experience within the context of Modern Therapy private practice. Please complete this as an add-on to our standard MT therapist application.

Name

First Name

Last Name

We love our fellows. Our fellowships are highly supported, training focused, and intensive in breadth of experience and opportunity. What makes you a good candidate for this type of experience?

Name 3-4 personal values you hold in your own life.

Please finish this sentence: "I know I will have been successful in life if":

Please complete this sentence: "I would be most proud if people remembered me by these characteristics":

Please complete this prompt: "To feel known, it's important to me that people understand this about me":

How would a supervisor describe you?

Complete this sentence: "When it comes to hard conversations I..."

Complete this sentence: "When it comes to details and organization I...."

When it comes to receiving constructive feedback I..."

What is most important to you as you complete this intern portion of your clinical career?

What's the best piece of feedback you've received and what made it impactful?

Describe your idea of an excellent supervisor. What would they be like?

Earning ones "clinical stripes" during ones intern/associate years requires great self-care. How do you support and care for yourself?

Let's end on a warm fuzzy: Who would you consider your role model (living or remembered) and what is it about them that moves and inspires you?