Personal Information
Current Citizenship
Enter your US citizenship status, country of citizenship, and other related information. When selecting your status, consider the following definitions which are adapted from the US State Department:
- US Citizen: An individual who was born in the US or attained citizenship through naturalization. Note that individuals who are currently applying for citizenship, but have not yet attained it, are not considered citizens.
- US Permanent Resident: An individual who holds a Green Card and is permitted to permanently live and work in the US.
If you are not a US or Canadian citizen, enter your Visa information in this section. Please note that we cannot advise you on your visa status or any related details.
Race
Select the option that best describes your race. This question is optional. The provided information may be used by ASHP for purposes such as efforts to improve diversity, equity, and inclusion in residency training. This information will also be available to residency programs in de-identified and aggregate format to support their efforts to recruit diverse applicants.
General
Preferred Name or Nickname
If you commonly use a preferred name that differs from your legal name, enter it here.
Additional Language(s)
Select any additional languages you speak other than English from the drop-down, then select your proficiency level. Note that you must be fluent enough in this language to conduct therapy. If you are fluent in more than one additional language, we recommend listing them on your personal statement or resume.
Felony Convictions
Indicate if you've ever been convicted of a felony. If you select Yes, provide more information about the situation in the field provided.
Curriculum and Non-Curriculum Based Internship Hours
Enter the total number of non-curriculum based and curriculum-based internship hours that you anticipate you will complete before graduation.