MSc in Psychological Wellbeing in Counselling & Psychotherapy
Specialising in Couples in Relationship Counselling & Psychotherapy

2017 Application Form CONFIDENTIAL

Please complete all sections in Black Ink: please continue on a separate sheet (clearly marked) if required.

PERSONAL DETAILS
Surname: / Forename(s):
Address & Postcode
Tel No: / Mobile No:
Email:

This course is for counsellors who have PG Diploma level training in individual counselling, or psychotherapists, who now wish to gain an MSc in Relationship Counselling.

We require a PG DIPLOMA QUALIFICATION or equivalent entry to this programme:
Training Provider / Date / Course title & level (PG Diploma etc)
Please give a summary of course content, and total number of hours training (eg 450hours):
OTHER RELEVANT EDUCATION AND TRAININGincluding other counselling qualifications
Training Provider & Address / Date completed / Subject, level grade achieved
Any counselling CPD over the last 12 months:
EMPLOYMENTEXPERIENCE: most recent first – please include any relevant volunteer experience
Employer’s Name & Address / Dates / Position and main duties

EVIDENCE in support of your application: Please do not attach a CV, as they will not be used to make selection decisions.Please continue on a separate sheet if necessary for any of the questions.

Please outline your interest in training as a Relationship Counsellor:
What personal qualities, skills and experience will you bring to this role? Please include reflections on your personal experience of relationships.
Please give an indication of how many counselling hours you have provided and the range of client issues you have worked with:
How do you think you will cope with the amount of study required and the time commitments of the course:
What challenges do you anticipate for yourself in the following areas of the programme:
  • personal and emotional development
  • theoretical understanding
  • written assignments
  • practice development

Current membership of relevant professional bodies:
REFERENCES: We require 2 references:
  • 1 from your counselling supervisor, previous trainer or present/previous employer.
  • 1 from a second person, could be as above but NOT a relative or friend.
Please arrange for your referees to complete the MSc Reference Form available on our website and return it direct to us.
DISABILITY/MEDICAL CONDITIONS:
Do you have any health conditions that may affect your placement as a counsellor:YesNo
If yes, please give details:
CRIMINAL CONVICTIONS
Do you have any criminal convictions?YesNo
If yes, please give details on a separate sheet, this should exclude spent convictions under section 4(2) of the Rehabilitation of Offenders Act
DECLARATION
I declare that the information I have provided in this application form is, to the best of my knowledge and belief, correct and complete.
Warning: if you include any details that you know to be false or if you withhold relevant information, you may render yourself liable to disqualification from the course.
SIGNED:DATE:

Closing date:to be confirmed

Please send completed form to Sophie Rogers, Clinical Practice Co-ordinator at The Spark:

via (emailed applications to be signed at the start of the course).

OR

via post (two copies): The Spark, 72 Waterloo St, Glasgow G2 7 DA

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