Training Application Form Counselling Children & Young People Personal Information

First Name

Last Name

Address

Address Line 2

City

County

Postal Code

Confirm Email

Phone Number

Mobile Number

Date of Birth

Stage applied for

Current family situation (single, partner, children, dependents, etc)

Any physical or emotional difficulty which has entailed treatment?

Previous and current experience of work, including voluntary work:

Activities and interests other than work:

Other courses and training attended:

Experience of counselling/therapy:

Using 300 – 350 words, please set out the reasons you are applying for this course now:

Circumstances in your current situation which you would like us to know about?

Are you aware of any learning difficulty, i.e. dyslexia, or any other reason why you might require additional support during the course? Please give details:

Please give an account of significant experiences in your life and how you feel about them?

Name and address of two referees and your relation to them (referees will be approached at our discretion):

For Diploma applicants we will ask for a short reference from your previous training provider; for Psychodynamic Psychotherapy applicants we will contact your current supervisor. Please provide details:

If this presents you with any issues please let us know below:

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