Whiteknights
PO Box 217
Reading RG6 6AH
Application for admission to postgraduate training
Flexible Professional Development in
Evidence-Based Psychological Treatment
Please complete this form electronically and return to:
Please contact the Charlie Waller Institute for further assistance if required on 0118 378 7531.
PLEASE NOTE THE FOLLOWING
Personal details
Please enter in these boxes the names as on your passport, or other items of ID.
Addresses
Please keep the University informed of any change to your current address as this is the address to which we will write. Please also ensure that we have a current e-mail address.
Residence
If you have not been permanently resident in the UK for the 5 years before the commencement of the programme you wish to study, please provide information about any periods of residence in the UK.
Academic or professional referees
Please details the names and addresses of two referees; one must be your current line manager, who can comment on your suitability for these courses. It is advisable to inform the referees to expect to be contacted, and that to check that they will be available.
Proposed programme of study
Please ensure it is clear which module/s you are applying for.
Disability/Special needs
If you have a disability, please tick the box on the application form, and give details (including, for UK students only, whether you are receiving a Disabled Students’ Allowance) in a covering letter/e-mail. The University needs to know the nature of your disability if it is to provide you with the best possible support. The information you provide will not affect the academic judgements about your suitability for the programme.
Previous education
University or college education
If you have a degree, diploma, professional or other qualification awarded by a university, college (or similar institution outside the UK), you may be asked to provide a transcript or worksheet if invited for interview.
Employment and work experience
It is important to include details of employment and work experience relevant to your application, particularly if your qualifications are not from the United Kingdom or if it is some years since you attended a course of study. If necessary, include such information in your additional statement.
Application Form Completion
Please save this form as a Word document. Please do not send it as a PDF or in any other format. It will assist us if when saving your application if you use your surname and initial in the filename e.g. SmithJP
The University of Reading Office use only
Application for admission as a postgraduate student
Please complete this form electronically and return to:
Please contact the Charlie Waller Institute for further assistance if required on 0118 378 7531.
Application No.
Date to Sch./Dept.
1 Personal details
Please note that you must use your full given names as stated on your ID card or in your passport
Family name/Surname Initials
Forenames in full
Title M/F Marital Status Date of birth
2 Contact Details
Current/term-time address / Home/permanent address if differentAddress 1 / Address 1
Address 2 / Address 2
Postcode / Postcode
Telephone No. / Telephone No.
Mobile No. / Work Tel No.
Email address/plus alternative if use two
3 Residence
Nationality and country of permanent residence
Have you been resident in the UK prior to this course?
Yes
If not, please give dates of most recent period of residence in the UK, and the reason for visit:
4 Fees
· I propose to self-fund and am able to meet the cost of the training, (please request a payments form)
· I am applying for funding through BHFT
· I have secured funding from my employer (non BHFT)
Please give details: Employers name, contact email and invoicing address.
Please complete payments form at the end of this application form.
5 Referees
First Referee – Current line manager / Second RefereeAddress 1 / Address 1
Address 2 / Address 2
Postcode / Postcode
Telephone No. / Telephone No.
Email address / Email address
6 Please indicate the module/s you wish to study
Your choices are subject to review by the course directors and will be discussed with you if necessary.
Introduction to evidence-based psychological treatment / 470 / PYMIN1 (20)
Introduction to evidence-based psychological treatment (APEL) / 175 / PYMIN3 (20)
Treatments and models1 / 585 / PYMTM1 (20)
Treatments and models2 / 585 / PYMTM2 (20)
Treatments and models3 / 470 / PYMTM3 (20)
Focused clinical training and supervision: basic level; complex problems and dissemination (subject to interview) / 4800 / PYMCT1 (20) + PYMCT2 (20)
Foundation skills for working with trauma and PTSD / 470 / PYMBWT (20)
Advanced skills for working with PTSD in specific populations / 585 / PYMAWT (20)
Cost of assessment: £175 per module
(APEL or Intro is a prerequirement for assessment on ALL modules)
Do you wish to be assessed?
7 Please indicate if you have a disability or special needs that may affect any area of the course including academic performance
8 Please indicate if you have any specific dietary requirements
9 Previous education
University or College education – including any current course
Degree / Class or grade / Subjects / University or College / Date of course / Graduation dateSchool-leaving examinations and school attended
10 Employment and work experience (expand if necessary)
Brief description of work and responsibility,Highlighting your clinical roles / Name of employer / Date of employment
11 Please give details of any training previously attended at Reading University.
12 Please describe your previous experience of psychological therapies, and in what context this was gained.
13 Please detail how completing this course will facilitate your future career plans.
14 Where necessary, please detail how your current working context will enable you to access psychological therapy practice cases during the course. (clinical only)
ALL APPLICANTS
I declare that the information given on this form is true, complete and accurate and no information requested or other material information has been omitted.
Name
Date
If any information on your application form is found to be false then this may lead to the withdrawal of your place at the University.
Please attach any additional statement in support of your application
APPLICANTS FOR BHFT FUNDED PLACES ONLY
NHS Line Manager Approval
Name of Line Manager....
Post Title....
Please see our website for terms and conditions (www.reading.ac.uk/charliewaller)
Additional Statement
IF YOU WISH TO BE INVOICED (we can only invoice registered organisations)