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Philadelphia Connections Application

Thank you for your interest in Philadelphia Connections! To better understand your areas of interest and to better understand the experience and education of students who are applying, we request that you have the following materials ready prior to applying for the EP program:

  • Complete academic information including academic instructor/liaison contact information.
  • If applicable, field placement information including address and complete supervisor contact information..
  • A comprehensive inventory of topics of your education and work experience.

Page 1

Please fill out the last name field
Please fill out the first name field
Please fill out the address field
Please fill out the city, state, and zip fields
Please fill out the mobile phone number field
Please fill out the email address field
Please enter the name of your current school
Please enter the degree that you are currently pursuing

Page 2

Please enter the degree that you are currently pursuing
Please enter the degree that you are currently pursuing
Please enter the degree that you are currently pursuing

Page 3

Please fill out your prior experience
Please fill out the total number of years you have spent in the behavioral health field

Page 4

Course

Part of Class

Workshop / Training

None

General Psychology

Geriatrics/Aging

Psychotic Disorders (such as Schizophrenia)

Mood Disorders (such as Bipolar Disorder)

Personality Disorders

Intellectual Disabilities

Autism Spectrum Disorder

Dual Diagnosis (mental illness & substance abuse)

DSM (Diagnostic Statistical Manual)

Psychiatric Medications

Integrated Healthcare (behavioral and physical health)

Cultural Competency/Awareness

Mental Health Recovery

Lived experience/Peer culture

Family inclusion

Telehealth/Telemedicine

Clinical Supervision (supervising others on clinical issues)

Administrative Supervision (Supervising other staff as employees—issues of attendance, punctuality, job performance, work load management, etc.)

Suicide Assessment

Self Care

Ethical Issues in Behavioral Health Settings

Resources available in the public Behavioral Health System of Philadelphia

Careers and jobs in Behavioral Health Settings

Information on becoming licensed in your profession

Behavioral Health policy or advocacy

Program planning or program development

The Philadelphia Behavioral Health system (DBHIDS, CBH, PMHCC)

Page 5

By entering my name and date below, I certify that the information entered into this application is correct and accurate. The entry of my name and date also confirms my understanding of and agreement with the policies specified in the Philadelphia Connections Handbook.

View the Enhanced Placement Seminar Program 2024-2025 Schedule

Thank you for applying for the Philadelphia Connections Program!

Your application has been submitted to our office administrator and we will be in contact with you shortly regarding your assigned group.  In the meantime, please be aware of updates coming to you soon.

If you have any questions about your application, please do not do hesitate to contact us.
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