Graduate Skills in Counselling – Application Form

Title
Forename*
Surname*
Date of Birth*

Address 1*
Address 2*

Town/City*
Postcode*

Email Address*
Telephone Number
Mobile Number*

Nationality
Country of Birth
Do you have any special requirement?

University/College/Secondary School

From
To
University or College Attended
Qualifications

From
To
University or College Attended
Qualifications

From
To
University or College Attended
Qualifications

Employment Details/Experience

Please indicate your employment history and detail any experience you have undertaken which you feel would support your application for the Graduate Certificate in Counselling:

From
To
Organisation/Employer
Experience, Job Title

From
To
Organisation/Employer
Experience, Job Title

From
To
Organisation/Employer
Experience, Job Title

From
To
Organisation/Employer
Experience, Job Title

From
To
Organisation/Employer
Experience, Job Title

From
To
Organisation/Employer
Experience, Job Title

References

We require two references to support your application. Please provide their details below.

Reference 1
Name
Reference 2
Name

Contact Number
Contact Number

Which course date would you prefer?

Have you/are you applying for the PG Dip?
YesNo

Once you have completed your interview, subject to offer and subsequent acceptance you will receive an invoice for the course fee of £1900 + VAT this has to be paid within 30 days or sooner if the course date is less than 30 days away.*
I acceptI do not accept

I understand that the programme is planned to go ahead face to face, however if guidance does not allow I accept that the programme will be delivered virtually. *
I acceptI do not accept

Graduate Skills in Counselling – Application Form

University/College/Secondary School

Employment Details/Experience

References

Reference 1

Reference 2