Level 4 Diploma in Therapeutic Counselling - New Course Joiner Form
Please fill out the below application form to join the Level 4 Diploma in Therapeutic 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 *
Your first name(s) *
Your surname *
Your date of birth *
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Telephone number *
Full address *
Post code *
Where did you hear about the Hub/Connect? *
Required
Which class would be your first choice to attend? If an option is missing, the class is full. *
Which other class could you attend? *
Required
Can you explain what interests you about becoming a counsellor? *
Please give details of any previous experience that you feel is relevant to this field. *
Please give details of any criminal convictions. *
Do you have any special learning requirements, learning disabilities or physical difficulties? Please give as much detail as you can.
Can you provide details of any reasons that you know of that would stop you attending the course and meeting the 85% attendance requirements? *
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. *
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 *
Address of your referee *
Referee email address *
Referee phone number *
Your relationship to the referee *
Please state whether you are currently or have previously studied with Astranti Connect (or the Devon and Cornwall Counselling Hub): *
Your last counselling training course was completed with... *
Please confirm you have completed (or are in the process of completing) the level 3 CPCAB training or equivalent *
I confirm I have downloaded and read the course document *
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