Volunteer Therapist Application Form
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Email *
Title *
Full Name *
Address and postcode *
Contact phone number *
How many days in the week are you available to volunteer? (We ask for a minimum of one day with at least four clients) *
Which days of the week are you available *
Required
Can you commit to a minimum of one year in placement? *
Do you require a work permit or any other kind of document to show that you have necessary permission to work/volunteer in the UK? *
Immigration, Asylum and National Act 2006  If you answer YES, please give your VISA number.
If you have accessed or currently in services for drug and / or alcohol treatment, mental health or ex-offenders, please give details:
It is our policy to support any staff with mental health issues as we value your lived-experience to inform your clinical learning.
Please tell us your reasons for wanting to undertake a psychotherapy placement at Power To Live Foundation *
Please tell us what you would bring to the organisation in terms of skills and experience relevant to the placement and to the charity. *
As part of this, please send us a CV detailing your prior work experience, and any relevant training/education.
Please share briefly your therapeutic approach and tools you use in counselling / psychotherapy (if you have any preferences). *
How many counselling session hours have you already conducted? *
Are you currently a member of recognised counselling body such as BACP UKCP and BABCP? *
Membership not required for placement but it is recommended that you apply.
REFERENCES: Please name TWO referees for whom a reference may be obtained. Where possible this should be a professional person such as an ex-employer, key-worker, college tutor, supervisor, etc; they should have known you for six months or more *
Please state: Name, Position, Organisation and relationship to you and contact number and email
Declaration of convictions: Have you ever been convicted of a criminal offence, received a formal caution, been bound over or received a conditional discharge? *
As many clients at Power to Live are vulnerable adults we are exempt from the Rehabilitation of Offenders Act 1974. All convictions, whether spent or unspent, must be declared. A full DBS check will be required for volunteers.
Would you be willing to undergo a Disclosure and Barring Service (DBS) check? *
Please note that you will not be asked to work with service-users until DBS checks have been returned. DBS forms are returned directly to the applicant.
Any other Comments
Declaration: To my knowledge the information above is correct. I understand that if I am appointed and this information is found to be inaccurate this may affect my continued position with Power to Live Foundation. *
Please Enter your name as an electronic signature.
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