Child Study Center Externship Application

Contact Information:

First Name:

Middle Name:

Last Name:

Street Address:

Address:

City:

State:

ZIP Code:

Home Phone:

Work Phone:

Mobile Phone:

E-Mail Address: *

Grad School:

Address:

Phone number:

Program:

Program Director:

Phone Number:

Email:

Year of Expected Graduation:

Externship to which Applying:

Names of Letter of Recommendation Writers:

Required Documents: Applicants should submit a single pdf containing a letter of interest; a writing sample (intake report preferred); an attestation letter from your graduate program stating your eligibility for the externship; two to three letters of recommendation (from professors or clinical supervisors); and your CV.

Letter of Interest:

Writing Sample (intake report preferred):

An attestation letter from your graduate program stating your eligibility for the externship:

Letters of Recommendation #1:

Letters of Recommendation #2:

Letters of Recommendation #3:

CV/Resume:

If you are unable to submit these materials, you may email them to lori.evans@nyumc.org, or mail them to:

Lori Evans, PhD
Director of Psychology Training
Child Study Center at NYU Langone Medical Center
One Park Avenue, 7th Floor
New York, NY 10016

Please contact Dr. Evans at lori.evans@nyumc.org if you have questions.