Training Application Form

Course applied for:

Foundation Year Long Course Foundation Intensive Option Diploma in Psychodynamic Counselling (internal applicant) Diploma in Psychodynamic Counselling (external applicant)

First Name

Last Name

Preferred name:

Address

Address Line 2

City

County

Postal Code

Confirm Email

Phone Number

Mobile Number

Date of Birth

Is English your first language?

If you have answered ‘No’ please give details of your first language and English proficiency:

How did you hear about our course?

Education history / previous courses and experience:

Education history / previous courses and experience: Please list all education and other courses you have attended (please list most recent first and if you require additional space please put on a separate sheet and email to trainingcoordinator@wessexcp.co.uk):

Course name:

Course provider:

Date of course

Please give details of course content:

If ‘No’ please give reasons:

Course name:

Course provider:

Date of course

Please give details of course content:

If ‘No’ please give reasons:

Course name:

Date of course

Course provider:

Date of course

Please give details of course content:

If ‘No’ please give reasons:

Course name:

Did you complete the course: Yes / No (delete as applicable)

Date of course

Please give details of course content:

If ‘No’ please give reasons:

Employment history (including voluntary work):

Current family situation:

Please give details of any mental health issues you have experienced:

Are you currently, or have you been in therapy? Yes / No (please delete as applicable).

If yes, please give details of your current and previous therapist including name, modality, start and end dates:

What have you learnt from these experiences (if applicable). Please write a minimum of 300 words:

Do you have any learning difficulties? Yes / No (please delete as applicable).

If ‘Yes’ please give details and indicate what level of support you feel you would require whilst on the course:

Do you have any physical disability? Yes / No (please delete as applicable).

If ‘Yes’ please give details and indicate what level of support you feel you would require whilst on the course:

Please answer the following questions in this section with a minimum of 300 words (there is no maximum)

Please describe significant experiences (including challenging) in your life and how you feel about them:

What do you think you could bring to this course, as a trainee in a group and as a counsellor?

What do you feel your strengths are?

The course will be challenging emotionally. What challenges do you feel you may face; what might you find difficult?

What concerns and anxieties do you have about the training?

Are you able to fully commit to the course in terms of time, emotionally and financially? There is a 90% attendance requirement to pass the course. Please comment below:

What do you think you will gain from this course?

What are your expectations from this course?

Why do you feel this is the right time for you to apply for this course?

Any other information you would like us to know about:

References: Please provide details of 2 referees (not family members or your therapist) who have known you for at least 2 years. At least one of these should know you in a professional capacity.

Name:

Address:

Email / Tel:

Capacity in which they know you:

Name:

Address:

Email / Tel:

Capacity in which they know you:

How long you have known them:

For Diploma applicants we will ask for a reference from your previous training provider:

Training provider:

Contact Name:

Contact email / tel:

Please submit a copy the following with your application: 1. A form of identification such as: • Passport • Driving Licence • Utility Bill showing your address as per your application

2. A recent passport style photo.

Please submit your application online and pay the interview fee per below:

Paying the application and interview fee:

By card – please call us on 01373 453355
By bacs to:

Wessex Counselling
Sort code: 40 52 40
Account: 00019093

You will be invited to interview once your application, above documents and interview fee have been received.

Please submit your application online and pay the interview fee per below:

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