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Level 5 Diploma in Psychotherapeutic Counselling - New Course Joiner Form
Please fill out the below application form to join the Level 5 Diploma in Psychotherapeutic Counselling course.
Once your application has been received, a tutor will contact you to assess your suitability for the course.
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Email
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Your email
Your first name(s)
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Your answer
Your surname
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Your answer
Your date of birth
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Telephone number
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Your answer
Full address
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Your answer
Post code
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Your answer
Where did you hear about the Hub/Connect?
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Google or equivalent search engine
Facebook
Instagram
Someone recommended us to you
I'm an existing student
Other:
Which class would be your first choice to attend? If options are missing, class is full.
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[500] Online: Friday daytime course - September 2023
Can you say what interests you about developing your counselling practice?
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Your answer
Please give details of your counselling practice so far or any other relevant work experiences
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Your answer
Please give details of any criminal convictions.
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Your answer
Do you have any special learning requirements, learning disabilities or physical difficulties? Please give as much detail as you can.
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Your answer
Can you provide details of any reasons that you know of that would stop you attending the course and meeting the 85% attendance requirements?
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Your answer
Have you experienced a mental health problem such as depression or anxiety, addiction, eating disorders or a personality disorder? If so, please provide details including the length of time since recovery.
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Your answer
Referee details
Please provide the details of someone who can act as a referee. A previous course tutor, employer or professional would be useful
Name of your referee
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Your answer
Address of your referee
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Your answer
Referee email address
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Your answer
Referee phone number
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Your answer
Your relationship to the referee
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Your answer
Please state whether you are currently or have previously studied with Astranti Connect (or the Devon and Cornwall Counselling Hub):
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Current student of Astranti Connect
Previously a student or Astranti Connect (or Devon and Cornwall Counselling Hub)
New student
Please specify what counselling course/qualification you have previously undertaken to qualify as a counsellor (e.g. CPCAB level 4 Diploma in Therapeutic Counselling):
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Your answer
Your last counselling training course was completed with...
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Your answer
Please estimate the approximate number of hours of personal counselling you have undertaken to date:
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Your answer
I confirm I have downloaded and read the course document
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I confirm
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