Exit this survey People Survey for Website Please enter as much of the requested information as you would like to appear on our website. Question Title * 1. Name and Degree Question Title * 2. Columbia University teaching appointment, if any (e.g. Lecturer in Psychiatry) Question Title * 3. Training Program Adult Psychoanalysis Child and Adolescent Psychoanalysis Accelerated Child Psychoanalysis Adult Psychodynamic Psychotherapy Child and Adolescent Psychodynamic Psychotherapy Parent Infant Psychotherapy Program Transference Focused Psychotherapy Visiting Candidate Other (please specify) Question Title * 4. Email (Please enter the email address you prefer to have listed on the site and viewable by the public. Columbia addresses are preferred but not required.) Question Title * 5. Preferred Office Telephone Question Title * 6. Fax Question Title * 7. Clinical office address Question Title * 8. Research Office Address Question Title * 9. Administrative Office Address Question Title * 10. Areas of interest (up to 100 words - could include your clinical interests, committee involvements, research or teaching focus, APM activities, etc) Question Title * 11. Professional Biography (a narrative version of your professional resume in 100-250 words) Question Title * 12. Selected Presentations/Publications (list up to five.) If none are listed, the header "Presentations/Publications" will not appear on the page. If more than 5 are included, the first 5 will be published. Question Title * 13. Grant Support Question Title * 14. Course/Supervision (list only supervision or teaching you are doing in the 2018-19 academic year at the Center in any of our programs) Question Title * 15. Education and Training Undergraduate: Degree, School, year of graduation Graduate/Medical School 1: Degree, School, Year of Graduation Graduate/Medical School 2: Degree, School, Year of Graduation Psychology Internship: Institution, Year of Completion Medical internship: Hospital, Year of Completion Psychiatry Residency: Training Program, Year of Completion Chief Residency: Training Program, Year of Completion Fellowship 1: Subject, Institution, Year of Completion Fellowship 1: Subject, Institution, Year of Completion Psychoanalytic Training: Institute, Year of Completion Question Title * 16. Honors (any you wish to include. If you do not wish to list any, the header "honors" will not appear on the page) The following information will not be shown on your profile page. We are collecting it so that those who wish can conduct an advanced search on the site ("e.g. a patient looking for a referral to someone who is child trained, female, and has an office on the upper west side."). For each item, choose all that apply. Question Title * 17. Gender Female Male Other (please specify) Question Title * 18. Degree Psychiatrist (M.D.) Psychologist (Ph.D. or Psy.D.) Other (please specify) Question Title * 19. Patient Population Children Adolescents Adults Question Title * 20. Practice Location(s) Downtown Midtown Upper East Side Upper West Side Westchester Connecticut Brooklyn Other (please specify) Question Title * 21. If you would like it to appear as an attachment on the page, please attach your CV DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File If you would like it to appear as an attachment on the page, please attach your CV Question Title * 22. We strongly encourage you to have a photo on your page. If you would like a picture to appear, please attach it here. DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File We strongly encourage you to have a photo on your page. If you would like a picture to appear, please attach it here. Done