IPA Interest-Free Student Loans
Candidate Loan Application Form
Send this Application form to: loans@ipa.org.uk by 1 June 2006.
1. First name:
2. Family name:
3. City:
4. Country:
5. E-mail address:
6. Name of your Institute:
7. Date of beginning of your psychoanalytical training
8. How many years of training have you completed at your Institute?
9. How many years do you estimate you need to complete your training?
10. How many patient hours do you see weekly?
11. How much do you earn per session (on average)? (Please, write all the sums in US dollars) ________
12. How much do you pay per session for your training analysis?______ Monthly:_______
13. How much do you pay for one supervision session?_____ Monthly:_____
14. What is your average yearly total income:_________
15. What size of a loan are you requesting in order to continue or to begin your psychoanalytical training?
16. Please, explain (in no more than one page) your situation and motivations for applying for a loan.
Signature:
