Pre-Clinical Courses 2017-2018

APPLICATION FORM

Infant Observation

Owing to the sensitive nature of the infant observation setting, the application and preparation processes are more complex for this seminar. Within your application, we ask you to provide details of two referees, one of whom should be someone who is familiar with your work. Once we have received your application, we will contact you to arrange an interview; if you are offered a place, this will be subject to references and to an enhanced DBS check (for which there is an additional fee payable).

Work Discussion and Classical Theory

For these modules, we ask you to provide details of one referee, who is familiar with your work.

Closing Date for Applications 16th June 2017

Name: ………………………………………...……..…...……………………………..…….…….. (Male/Female)

Address: ……………………………………………………..……….………………………………………………...……

…………………………………………………………….……………..……… Postcode ………...………………..

Telephone (days) …………………………..…..……..… (evenings) ………….…………….….……………….

Email: ……………………………………………………………………………………………………….………………..

How did you hear about the course(s)? …………..…………..…………………….…………………………………

Please tick below which courses you are applying for. Please note that all courses are run on a Monday. Courses are scheduled between 3.00pm to 8.45pm in a program designed to meet the individual choices of up to as many applicants as possible. At this stage, you should set aside this entire time period, your individual programme will be confirmed if a formal offer of place is made to you.

Infant Observation
Work Discussion
Classical Theory

Since this does not necessarily guarantee a place on this session, please indicate if you would consider a place on another module:

…….………..…………………………….…………………………………………………………….………………………

Have you completed the SIP Introductory Course and if so when? ……………...…..…………..…..…………

If not, what experience do you have of psychoanalytic theories and concepts……………...…..…………..…..……………………...…..…………..…..………………………...…..……

Pre-Clinical Application Form 2017 -2018 Page 5 of 5

Please give details of any personal therapy: ……………...…………………………….…………...…..…………

…….………..…………………………….…………………………………………………………….………………………

Brief details of education and professional training: ……………...……………………………………..…………

…….………..…………………………….…………………………………………………………….………………………

Work situation and brief details of work history: …………………………………………………...………………

………………….……………………………………………….………………….…………………………………………..

………………………….……………………………………………………………………………………………………....

Please say why you would like to do this course, giving brief relevant details of your experience, work, and/or interests:

Referees

Referees should have known you personally for a significant period and at least one of your referees should know you in a professional or academic capacity. The names of relatives or friends should not be given as referees.

Referee 1 (who should be familiar with your work) Referee 2 (infant observation applicants only)

Name ………………………………………...... ……… Name ……………………………..……………..…

Address …….…………….……….….….….………… Address …….…….………………….…….………

…………………………………………..…….…………. ………..………………………………..…………….

………………..….… Postcode ………….…………… ………………..….… Postcode …………..………

Telephone (days) ….…………………….…...……… Telephone (days) ….……..……………….………

Telephone (eves) ….……………………….….……… Telephone (eves) ….……………….…….………

Email ……………………………………….….……… Email ………………………………..…….………

Relationship to you…………………….…..….……… Relationship to you ……………………….………

Fees payable

For the year 2017-18 Pre-Clinical Course Fees are £850 per course which includes a non-refundable deposit of £200.00 per course (plus DBS fee for the Infant Observation course – see Payment Terms.) Deposits are payable upon application. Fees are reviewed annually. They are liable to increase in line with the market. Places will be offered following the closing date and, where applicable, interviews. Students applying for the Infant Observation course who are not offered a place following interview will have their deposit refunded less an administration fee of £60.00.

Acceptance of an offered place is a contractual commitment to pay the balance and fees are not refunded if you subsequently withdraw for any reason. By applying, you are accepting these terms (please find full payment terms on page 4).

Please tick as appropriate:

□ I enclose a cheque for £ …….……… made payable to ‘SIP’ being a deposit of £200.00 per course.

□ I have transferred a payment of £ …….……… being a deposit of £200.00 per course to SIP’s bank account (see Payment Terms for SIP’s bank account details).

□ I confirm I have read and agree to the payment terms.

Signed ……………………...... …….....……………… Date ………...... ……………

Equality Monitoring Form

The Severnside Institute for Psychotherapy has a policy to monitor all applications to help us reach more diverse communities than we currently do. As part of this, we would be grateful if you could complete the anonymous Equality Monitoring form (available by request from the General Administrator) and return it with your application, in a separate envelope if you prefer.

Please return your application form to:

Administrator, SIP (Pre-Clinical Courses), 11 Orchard Street, Bristol BS1 5EH

Please apply by the date shown for the module.

Late applications will be considered if places remain, but make planning more difficult.

Payment Terms for Pre-Clinical Courses 2017-2018

When you accept a place ona Pre-clinical course you are making a contractual commitment to pay the full fee for each academic year (or term if starting part way through an academic year) that you attend the course.

1 – Deposit

A non-refundable deposit of £200 per course is payable with your application. In the event thatthe course is oversubscribed at the time of your application your deposit will be returned to you.

Infant Observation students please note:

i. Only one deposit is required for the duration of this course, which is paid as part of first year fees.

ii. If a student is not accepted on to the course following interview, the deposit paid will be refunded less an interview fee of £60.00.

2 - Invoices and Payment of Fees

An invoice for the remaining fees to be paid will be issued when you have accepted an offerof a place on the course(s). Fees may be paid by one of the following methods:

Payment of Fees by Cheque or Online Bank Transfer

The balance of fees payable should be paid within 28 days of the invoice date or (in the case of late applications) on the first night of the course if there are less than 28 days between invoicing date and the start of the course. Payment should be made to:

Bank: CAF Bank Ltd.

A/c Name: Severnside Initiative for Psychotherapy

A/c No. 00001001

Sort Code: 40-52-40

Ref. PreC + your surname (e.g. PreC Smith)

Payment of Fees by Direct Debit

If you request to pay fees by Direct Debit, we will ask you to complete a Direct Debit Form, agreeing to pay any outstanding fees in two instalments on the 1st September 2017 and 1st December 2017. The first instalment of fees must be received before the start of the course. If, for any reason, an instalment (or instalments) is not paid to SIP’s nominated account, the total value of the missed instalment(s) should be paid by cheque made payable to ‘Severnside Institute of Psychotherapy’ no later than 28 days after the final instalment by Direct Debit is due.

Infant Observation students please note:

i. Students joining the course mid-academic year will be asked to pay fees for the remainder of that academic year by cheque or online bank transfer only, but will have the option to pay by Direct Debit for courses starting in the following autumn term.

Ii An additional fee will be payable by Infant Observation applicants requiring a DBS check. This fee is payable directly to the DBS check provider, full details of which will be given to you. It will be no more than £60.

3 - Late Applications

Late applications will be considered if there are places remaining after the closing date. In the case of

extremely late applications, fees (including the deposit if not already paid) should be paid in full by online

transfer or cheque on the first night of the course at the latest. If you have requested to pay fees by

instalments, a Direct Debit Form together with a cheque equal to the value of the deposit and the first

instalment must be submitted on the first night of the course at the latest.

4 – Refunds

Fees are not refunded if you subsequently withdraw, unless your place(s) can be filled by someone on the

waiting list, in which case your fee will be returned to you.

5 – Deferrals

If your studies are deferred to a future year, your deposit payment will be carried forward to the year that

you have agreed with the Course Leader to resume studies. Any fees paid at the time of deferment will also

be carried forward to that year. An administrative fee may be payable if subsequent deferrals are

requested. Infant Observation students will be required to pay DBS fees if the check is in process at the time of deferment. SIP reserves the right to request that a student undergoes an additional DBS check when the deferring student takes up his/her place if it is thought necessary.

6 - Non-payment of Fees

Please note that students cannot be credited with having completed the Pre-clinical course(s) until all

outstanding fees pertaining to those courses have been paid.

7 - Course Cancellation

In the event that there are insufficient applicants, the course will not run and all fees and deposits will be

returned.

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