CTCC - Application Form
If you have any questions please email us: contact@traineecounsellor.co.uk

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I am applying for: *
Full Name: *
Date of Birth: *
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Address inc. postcode: *
Phone number: *
Email address: *
Please briefly share why you are interested in taking this course: *
How will you be funding this course? *
Do you have any previous experience of helping and/or counselling work? *
Do you have any learning needs, disabilities or mental health diagnosis that we would need to know in order to help you? *
We ask this to ensure we can make reasonable adjustments to support you.
Do you currently have any mental health challenges or concerns e.g., history of depression, recent bereavements, or significant life changes? *
Do you have any medical conditions including heart complaints or epilepsy, etc.?
*
Is there any additional information that you would like for us to know at this stage?
Where did you hear about us? *
By submitting this application you grant CTCC permission to store your data and contact you to arrange an interview. *
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This form was created inside of Coleshill Trainee Counsellor Centre (CTCC).

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