Application Form

personal details:

Name

Address

Phone Number

Email address

Date of birth

Next of kin name

Address (if different from above)

Qualifications/ experience:

Do you have any transferable qualifications?

Yes No

Please write details here

Do you have any previous counselling or transferable experience? (i.e nurse, social worker, key worker, etc)

Yes No

Please write details here

Course Applying For:

Which course are you applying for?

Do you have any additional needs that you would like us to know about for the purposes of learning and environment?

Yes No

Please write details here

Funding Information:

Please tell us how you intend to fund your training:

Please advise in the box below if you have any Questions or queries regarding funding.

Personal statement:

Pleases use the box below to tell us a little bit about yourself and why you have chosen to study your chosen course in counselling.

Disclaimer :

All information is stored on an encrypted system and completely confidential.

A £100-£400 deposit is requested upon acceptance onto the course of choice, amount of deposit is dependant on level of learning.

Psycotherapy & Counselling