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Dear Student,
Pursuant to the Abraham S. Fischler College of Education (FCE) Student Grievance
Procedure, the Grievance Form is for use in filing a grievance when a satisfactory
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will no longer be eligible for review. Students are encouraged to submit the Grievance
Form, and any supporting documentation, well in advance of the fifteen (15) day
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Cardinal Station Newburg Center for Primary Care
215 Central Avenue, Suite 100 1941 Bishop Lane, Suite 900 215 Central Avenue, Suite 205
Louisville, KY 40208 Louisville, KY 40218 Louisville, Ky 40208
I:\FCM\Phyllis Harris\Forms\New Patient Pkg Components
UofL Department of Family & Geriatric Medicine
Dear New Patient,
Welcome to your University of Louisville Physicians Family practice! We
are offering patient-centered medical care and are enthusiastic about our
relationships with our patients. In order to better serve your needs, we are
enclosing several forms and ask that you completely fill each form out.
The first sheet will help us learn more about you; please completely fill out this
form about your family history. The next sheet is titled, "Authorization for the
use and/or Disclosure of Protected Health Information", and you will need to
completely fill that out for our doctors to treat you to the best of their ability; it
gives us permission to review your medical records from your previous primary
medical facilities.
Following, please completely fill out the Registration, Social Services & Consent
Form. Next, you will find our Privacy Notice, followed by an acknowledgement that
you have received and understand our Privacy Policies. Finally, the last form is the
Office Acknowledgements and Policies form. Please read carefully and sign
your name at the bottom of the letter.
Please make sure to bring all of these forms with you to your first office visit.
Do not mail them back to the office. Also, please remember to always
bring your picture ID, current insurance cards and your co-payment. If your
health insurance requires you to select a primary care doctor please do so prior to
your office visit. Please bring in any and all medication you take, in their
original bottles, to your appointment.
If the patient is under 18 years of age he or she must be accompanied by an
adult and will need to bring a copy of their current immunization certificate.
Please arrive 15 minutes ahead of your scheduled appointment time so that if
you have questions about these forms or we need more information, we can
address it all prior to your appointment.
We look forward to seeing you!
University of Louisville Physicians
UofL Family and Geriatric Medicine

Voter Information

----MP;ycim;vuw Dear Prospective Applicant, Thank you for your interest in our Doctoral Internship in Health Service Psychology training program! The Training Staff are proud of the comprehensive training experience we offer our interns. We have provided information on our website to help prospective applicants determine whether or not our site would be a good fit for their training and career goals. The Training Staff are highly invested in providing a good training experience, and we enjoy the opportunity to work with bourgeoning professionals. We hope that the information provided on our website is helpful to you as you consider your internship options. If any questions remain after your review of these materials, please feel free to contact the Training Coordinator, Christina Carroll-Pavia, Ph.D., for more information. On behalf of the staff at Counseling and Psychological Services (CAPS), we wish you the best in your internship application and selection process! Cheers, Christina Carroll-Pavia, Ph.D. Training Coordinator Phone: (657) 278-3040 Email: ccarroll@fullerton.edu Training Program Introduction Counseling and Psychological Services (CAPS) at Cal State Fullerton offers an extensive, APPICmember Doctoral Internship in Health Service Psychology for doctoral-level graduate students in clinical and counseling psychology programs. Since CAPS provides services to all registered students at CSUF, we are able to provide interns with a wide variety of experiences within the clinical and educational services of the center. Training and competence in providing developmentally appropriate clinical assessment and individual therapy services to a culturally diverse, adult college student population is emphasized. In addition to individual therapy, interns have the opportunity to participate in the co-facilitation or process observation of group psychotherapy with a staff counselor. Interns participate in outreach activities such as classroom presentations, workshops, resource fairs and consultation with faculty, staff and student groups. Interns provide triage and crisis services, as well as attend meetings and undertake special projects that are typical of university counseling center settings. CAPS' training program focuses on the following areas of professional skill development and competence: • Generalist Clinical Practice • Providing Brief, Time-limited Therapy • Multicultural Counseling and Working with Diverse Populations • Crisis Intervention • Providing Outreach and Consultation • Professional Development Issues and Processes Interns will be exposed to a variety of therapeutic modalities and styles, and will gain experience working with a wide range of psychological disorders. Throughout the training year, interns will address a range of developmental, ethical, and professional issues that are common to mental health practice in university counseling center settings. CAPS' training program typically includes opportunities for the following activities: • Providing individual, couples, and group counseling within the brief therapy model • Conducting walk-in and triage crisis assessments • Conducting intake evaluations • On-site individual and group supervision • Administrative tasks such as clinical documentation and case management • Consultation with CAPS staff and health professionals at the Student Health Center • Consultation with in-house psychiatric staff • Didactic seminars focused on a variety of clinical and professional topics • Participation in weekly staff meetings and clinical team meetings • Providing psychoeducational programming, outreach, and consultation services to the CSUF campus • Participation in special projects that benefit CAPS' clients and the university community • Numerous opportunities for increased self-reflection, self-awareness, and overall professional development More detailed descriptions of our internship and training activities can be found below. Training Program Philosophy The doctoral psychology internship at CAPS utilizes a practitioner-scholar model of training. As such, the program is designed to be a forum for advanced learning of and practice in the art and the science of psychology in a setting where the open-ended nature of development is recognized and valued. We assist our interns in refining their practice as formed through both the processes of experiential practice and engagement of scholarly knowledge. Our program is grounded in a strong emphasis on the development of practitioners who have a working knowledge of accepted ethical and legal standards of practice, and who conduct themselves and their practice within these guidelines. Training Program Goals and Objectives Our overarching goal is to facilitate the development of psychologists who are able to practice competently and independently in a number of domains. While we recognize that one's internship setting may not be reflective of one's ultimate career path, our program is designed with an emphasis on strengthening skills in areas that are typical of professional work in university counseling center settings. We aim to train generalists who are adept in providing competent and effective psychotherapy, assessment, and crisis intervention for diverse populations and communities within a brief model. We value a philosophy of wellness and prevention, which is exemplified in the importance we place on providing collaborative outreach and consultation to our campus community. Finally, we support and encourage the ongoing process of professional development, recognizing the significance of self-awareness and productive self-reflection throughout this process. Ultimately, we strive to train interns who will subsequently enter the field as competent, ethical, and compassionate professionals. The specific program goals and objectives are as follows: GOAL 1: Development of generalist psychologists who are able to function competently and independently in a number of domains of psychological practice, with an emphasis on development of professional skills that are typical of professional work within a university counseling center. • OBJECTIVE 1A: Develop competence across a breadth of psychotherapy and assessment services. • OBJECTIVE 1B: Develop competence in crisis assessment, intervention, and treatment planning. • OBJECTIVE 1C: Develop competence in providing services within a time-limited model. • OBJECTIVE 1D: Develop competence in providing outreach and consultation services within a university community. GOAL 2: Prepare interns to provide competent and effective services for diverse populations. • OBJECTIVE 2A: Develop competence in providing psychotherapy and assessment services to clients of diverse demographic backgrounds. • OBJECTIVE 2B: Develop competence in providing consultation and outreach services to clients of diverse demographic backgrounds. • OBJECTIVE 2C: Develop competence in assessment and treatment of clients presenting with a broad range of clinical presenting concerns. • OBJECTIVE 2D: Develop self-awareness and appropriate consideration of intern's own relevant diversity and cultural factors when interacting with clients, colleagues, supervisors, and the broader community. GOAL 3: Prepare interns for post-doctoral supervised experience upon completion of the internship, and eventual independent practice and licensure as a psychologist. • OBJECTIVE 3A: Develop professionalism and development of a professional identity that is consistent with the expectations of the field. • OBJECTIVE 3B: Develop consistent behaviors in line with existing ethical standards, agency and organizational policies, and state laws governing the practice of psychology. • OBJECTIVE 3C: Develop confidence in the variety of roles undertaken during internship. • OBJECTIVE 3D: Develop ability to accurately self-assess. • OBJECTIVE 3E: Develop ability to appropriately participate in self-reflection and to productively use self-reflection and self-understanding for ongoing professional development and improvement. ----ko;xisq;jab

I will be out of the office from Tuesday, February 18 through Friday, February 21. I will have access to email and will reply if necessary. All other emails will be returned on Monday, February 24. Thank you!

--

Services Manager

Recreation

573-874-7202

----zw7YtGSN;LXfTZo

Dear Prospective Ed.D., Higher Education Strand Applicant:
We are very pleased that you are interested in the Higher Education Strand of CCSU's Doctor of
Education (Ed.D.) in Educational Leadership, designed for current higher education professionals
who aspire to leadership positions on college or university campuses. We look forward to receiving
your application.
As you complete your application, keep in mind the following admission criteria:
1. Master's degree from an accredited institution of higher education in a discipline or
professional field that is relevant to the Ed.D. in Educational Leadership.
2. A 3.00 or higher cumulative average (GPA) in all graduate coursework.
3. Two or more letters of reference from leaders in postsecondary education familiar with
your work. Ask your references to use the form on the next page.
4. Résumé that illustrates important work-related experiences with an emphasis on yo ur
work as a leader at postsecondary institutions of higher education.
5. Acceptable scores on the General Test of the Graduate Record Examination (GRE) taken
within five years of your application.
6. A personal statement covering six important topics:
• Career goals
• Intended area of individual specialization
• Reasons for pursuing a doctorate
• Commitment to residency requirements (one three-day weekend in the first spring
semester, one full week each of the first, second, and third summer sessions)
• Commitment to enrolling in two cohort courses each spring and fall semester
• Commitment to summer enrollment during each 8-week summer session
7. If selected as a finalist, a satisfactory interview with the admissions committee.
We accept new students in alternate years only. Applications are due by October 1, 2017.
Admission standards are rigorous, and not everyone who meets our standards wil l be accepted.
Please note that the admission process calls for submission of materials to two locations. The last
page of this packet is a checklist of the various steps. Submit your Graduate Application and $50
application fee online. Transcripts from every college you have attended as an undergraduate and
graduate student should be submitted to Graduate Admissions in 102 Barnard Hall. In addition you
must send the following materials directly to the Ed.D. Program (attention Rouzan Kheranian) in 320
Barnard Hall:
1. Two letters of recommendation from educational leaders. Use the Reference Form (page
2 of this packet).
2. Your personal statement attached to the form on page 3 of this packet.
3. Your résumé.
4. Your GRE scores. When requesting that scores be sent, use GRE reporting code 3143 to
assure that the Ed.D. office receives your scores.
Cordially,
Peter F. Troiano, Ph.D.
Ed.D. Program Direct or, Higher Education Strand

----t1QCtdb5;cbKmea Dear Utility Customer: Thank you for your interest in the City of Germantown paperless utility billing program. Please fill out the information below to activate paperless billing. To access your account, visit www.germantown-tn.gov, select "online services" then choose "utility payment and information." There are many benefits of the program including:  Email notification that your bill has been processed  Ability to view your bill online  Set up payments via credit card or electronic check If you do not receive an E-notification email, you are still responsible for your bill. If you change or update your email address, you must notify the City in writing by sending the form to our Utility Billing Specialist at 1930 S. Germantown Road, Germantown, TN 38138. Please mail, fax (901-751-7558), or drop off the completed form to the City of Germantown. If you have any questions concerning the program, call (901) 751-7605. I have read and understand the above and agree to comply. _________________________ ___________________________ Signature Date _________________________ ____________________________ Water Account Number Email Address

Re: Application Instructions for LifeSpan, Inc., Representative Payee Services Dear Payee Client or Representative: Thank you for your interest in having LifeSpan service your Representative Payee needs. On our website, the forms are separated into two categories: Intake Forms and Representative Payee Information Packets. 1. Please print and/or view the information listed under Client Bill of Rights & Responsibilities. This packet explains our services and your rights and responsibilities as a Representative Payee client. This packet is for you to keep and review as needed. 2. If you are interested in Representative Payee services, you have two options. You can either: SUBMIT ONLINE—complete the online form listed under Intake Forms which is labeled as Intake Form and then click "submit" to send the information electronically to our office. We have a secure website and your information will be securely transmitted to our organization. OR PRINT—print and complete the appropriate form(s) listed under Intake Forms. The form labeled Intake Form must be completed for all new Representative Payee applicants. Upon completion, mail the form(s) to us at: LifeSpan, Inc., 1900 Fairgrove Avenue (Rt. 4), Hamilton, OH 45011. You may also bring the papers to our office at this location Monday‐Friday between 8am and 5pm. The papers can also be faxed to our office at: 513‐868‐ 3249. 3. If you are a first‐time payee client (never had payee services with a company or relative), the Physician Form needs completed. This form is requested by the Social Security Administration and is listed on our website. Please print a copy of this form and have it completed by your physician and returned to us with your Intake Form…either attached to your electronic submission or included with your paper application. NOTE: If you have a guardian, the Letter of Guardianship should also be submitted with any payee intake forms received…either attached to your electronic submission or included with your paper application. If you have any questions, please do not hesitate to contact us. You may call Cathy B. at 513‐413‐0918, Kathy M. at 513‐388‐6058, Stefanie C. at 513‐276‐5419, Sue H. at 513‐388‐6066, Nicole R. at 513‐266‐8444, or Jesi T. at 513‐620‐3738. We look forward to working with you. Sincerely, LifeSpan Representative Payees Fax: 513‐868‐3249 posted by Fitzgerald Randolph at 7:02 AM 0 Comments: Post a Comment << Home About Me Name: Fitzgerald Randolph View my complete profile Google Search Web This Blog Links Home CNNCD.COM Health Body Guide 74211.com Make money with web hosting Playing Game Make Money Previous Posts Hey, prettyricky56! You have 8 new matches: Joanne... Woah, you seem to caught the interest of sexycandy... Match Request Accepted SquirtStar4u has given you a like! novagirl032 sent a private message to you sarxxx wrote you a message Match Request Accepted You got a private message from Ch3rrySizzlin22 Randolph, still need money to pay for your moving ... 28 members checked you out Archives October 2008 January 2012 September 2015 February 2016 March 2016 April 2016 May 2016 June 2016 July 2016 August 2016 September 2016 October 2016 November 2016 December 2016 January 2017 February 2017 March 2017 April 2017 May 2017 June 2017 July 2017 August 2017 September 2017 October 2017 November 2017 December 2017 January 2018 February 2018 March 2018 April 2018 May 2018 June 2018 July 2018 August 2018 September 2018 October 2018 November 2018 December 2018 January 2019 February 2019 March 2019 April 2019 May 2019 June 2019 July 2019 August 2019 September 2019 October 2019 November 2019 December 2019 January 2020 February 2020 March 2020 April 2020 May 2020 June 2020 July 2020 August 2020 September 2020 October 2020 November 2020 December 2020 January 2021 February 2021 March 2021 April 2021 May 2021 June 2021 July 2021 August 2021 September 2021 October 2021 November 2021 December 2021 January 2022 February 2022 March 2022 April 2022 May 2022 June 2022 July 2022 August 2022 September 2022 October 2022 November 2022 December 2022 January 2023 February 2023 March 2023 April 2023 May 2023 June 2023 July 2023 August 2023 September 2023 October 2023 November 2023 December 2023 January 2024 February 2024 March 2024 April 2024 May 2024 June 2024 July 2024 August 2024 September 2024 October 2024 © 2006 drug florida in rehab | Health Body guide No part of the content or the blog may be reproduced without prior written permission. Learn how to make money with web hosting.