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Full name:
Date of Birth: / Age: / Gender:
Ethnic background
(Include iwi, hapu if appropriate):
Present Address:
Email address:
Home phone: / Work phone: / Mobile phone:

Please complete and submit this Counsellor Education application form by 31 October. Earlier submission is recommended.

* This form is an application to the Counsellor Education Programme, Master of Counselling Degree. Completed application forms should be posted to Courtney Kelly, School Administrator, Te Oranga School of Human Development and Movement Studies, Faculty of Education, University of Waikato, Private Bag 3105, Hamilton 3240. Your application will be considered by a selection panel.

* You must also submit an Application to Enrol (ATE). This is your formal application to enrol at The University of Waikato. If you have specific questions about your ATE, please phone 0800 WAIKATO.The online ATE is located at weblink https://sase.waikato.ac.nz/app/NewStudent/ApplicationToEnrol Your academic record must satisfy the Academic Board that you are permitted to enrol in a masters degree programme.

* The selection process includes a full day selection process with members of the Counsellor Education Selection panel on Wednesday 9 November in Hamilton. It will take place in a group format and you will need to schedule a full day for this purpose. We will send you more details about this in due course.

Please supply two references on the attached referee’s report form and include them with your application. We ask for the contact details of the authors of these references so that we might contact them if we need to clarify anything they write. Please sign below your permission for us to contact them. Supplying the references themselves is your responsibility.

I give permission for the selection committee to contact these referees (named below) to seek clarification of anything in their written references which are attached.

SIGN HERE ______

Date

Referee 1 Referee 2

Name:

/

Name:

Address:

/

Address:


This application form is the first step in the selection process. We appreciate being given sufficient detail on which to base decisions about inviting candidates to the selection day. Please adjust the length of formatting on this form to fit what you write.

Please give clear details of your completed qualifications, including the subjects that you majored in, in your undergraduate degree. If your previous study/undergraduate qualification is not from University of Waikato, please provide an authorised photocopy of your academic transcript (a copy which has been signed by a JP who witnessed the original).

What interests you about what you know about the University of Waikato Counsellor Education Programme?

What hopes, expectations and aspirations do you have when you consider professional education with us?

What abilities would you most like us to appreciate about you in relation to your present helping or counselling knowledge?

What other counsellor training or education have you had? Please supply details.

What aspects of counselling are you most interested in learning more about in your counsellor education?

What matters do you think might get in the way of accomplishing your goals if you are accepted into our programme?

What particular fields of work do you anticipate using your counsellor education for?

Do you intend to enrol full time or part time? Which papers do you intend to enrol in for the year 2017? (Please consult the Counsellor Education Programmes Handbook for guidance on suitable programmes of study.)

In what settings do you anticipate being able to complete the practicum requirements for the counselling programme?

Employment History

Give employment history, adjusting formatting as necessary. Include full or part-time employment where such experiences are relevant to the counsellor education programme. Begin with your most recent experience and work backwards. (Please use the format below as far as possible, by adapting your CV to this format.)

Name and Address of Employer / Position and Duties / Dates
FROM TO

volunteer work experience

Include below any volunteer experiences you have had which you believe are relevant to the Counsellor Education Programme.

Name and Address of Employer / Agency/Organisation / Position and Duties / Dates
FROM TO

Workshop and PROFESSIONAL EDUCATION experiences

In-professional education or training, workshops, and so on, which may be directly related to your counsellor education goals, but are not on your academic transcripts. Extend or reduce the length of this section as needed.

Type of Training or Experience / Offered By / Dates
FROM TO

Declaration of personal circumstances

1. Have you ever been convicted of a criminal offence? Yes No

If yes, please supply details here, or contact the Director of Counsellor Education directly.

By signing this application you agree and acknowledge that in the event that the University at any stage becomes aware, through information obtained from the NZ Police Licensing Vetting Service Centre or otherwise, that you have a criminal conviction which you have not declared the University in its sole discretion may immediately decline your Application to Enrol, or cancel your Enrolment Offer or Enrolment Agreement (as the case may be). Please note that police vetting will be a requirement following selection.

2. Have you ever been subject to disciplinary procedures by a professional organisation such as NZAC, ANZASW, NZAP? Yes No

If yes, please supply details here, or contact the Director of Counsellor Education directly.

3. Counsellor education and counselling practice require considerable personal resilience (see pages 9-10 Counsellor Education Handbook). Are there or have there been any circumstances in your own life that might impact on your learning or counselling practice?

Yes No

If yes, please supply details here, or contact the Director of Counsellor Education directly.

I DECLARE THAT THE RESPONSES TO THESE QUESTIONS ABOUT MY PERSONAL CIRCUMSTANCES ARE TRUE

Sign here Date

Personal information

Please provide on extra sheets any further personal information which you consider to be relevant to your application (health, family circumstances, life experiences, beliefs, interests).

Sign here ______Date ______