Preferred Training Location:

Please tick your first and second preference (where applicable) of training time and location:

1st / 2nd
Year 1: / Monday Daytime
Year 1: / Monday Evening

BEDFORD

The Counselling Foundation - Bedford Centre

Bates House

12 Foster Hill Road

Bedford MK40 2EN

1st / 2nd
Year 1: / Wednesday Daytime
Year 1: / Wednesday Afternoon
Year 1: / Wednesday Evening

ST ALBANS

Training Centre

1 College Yard

Lower Dagnall Street

St Albans AL3 4PA

Dates, times and course venues are set according to demand and so are subject to change. The Training Centre reserves the right not to run the course if recruitment does not reach the minimum numbers and any monies paid will be refunded.

Please answer the questions below noting that all answers will be kept strictly confidential.

  1. What has led you to make your application to join the Diploma Course Programme now?
  1. Please list relevant counselling courses attended of at least one year’s duration:
  1. What experience of counselling work or work within a helping relationship do you have?

Please be specific about the nature and extent of your work and whether it is in a voluntary or paid capacity.

4.On a separate sheet of paper please give an account of significant life experiences/changes/loss and how you feel towards them (no less than 250 words and no more than 500 words).
5.Details of any significant emotional or physical illness

Please indicate if you have received personal counselling, psychotherapy, psychoanalysis or any sort of psychiatric help any time in your life. Please state any physical illness for which you have been treated in the last two years:

  1. Have you received treatment in the last 3 years for any form of addiction? If so, please state briefly.
  1. Do you have any special needs/disabilities, which we should be aware of when considering your application? If so, please state briefly.
8.Have you, or a family member, had contact with one of our Counselling Centres; either in the past or currently?

If yes, please specify which centre and the nature of the involvement.

Names and addresses referees:

INTERNAL AND EXTERNAL APPLICANTS

Referee 1: We would like a characterreference from someone who knows you in a work or training capacity, but is neither a member of the Foundation staff nor a student on any of our courses.

Name ______

Address ______

______Postcode ______

Tel ______

E-mail ______

EXTERNAL APPLICANTS ONLY

Referee 2: We would like an academic reference from your previous Course Tutor.

Name ______

Address ______

______Postcode ______

Tel ______

E-mail ______

Course Fees

A fee of £400 payment (£100 registration fee and £300 deposit) is payable at the time of application.

You may cancel your application and you will be refunded all monies any time up to 14 days from receipt of your application form. After 14 days, the deposit and registration payment are non-refundable. The deposit will be taken off your course fees if you are successful in securing a place on the course. Please note the £300 deposit is only refundable in the event that your application is unsuccessful and you will be informed of this decision in writing by the 11th July 2016. Any refund will be paid to within 30 days of notification.

Payment of the deposit allows you to apply and be considered for (but not guaranteed) an internal placement at The Counselling Foundation* and enables The Counselling Foundation to plan the Diploma for the upcoming academic year.

Our courses are likely to be oversubscribed and internal placements are limited. We therefore encourage early applications and those applicants who return their application form by the 29thApril 2016 will be eligible to take advantage of an 5% early bird discount when this year’s course fees are paid as a lump sum.

Subject to receipt of the deposit and the registration fee, successful candidates will be required to pay the course fees in accordance with the below options no later than 30th August 2016.

The following course fees apply**;

  • For those students starting the Diploma year 1 training in 2016/17 and on internal placement the course fees with be £3,250 + £350 = £3, 600
  • For students starting the Diploma year 1 training in 2016/17 and with an external placement the course fees will be £3,250.

*Please note that your Diploma 2 fees in 2017/18 will be £3,750 and £3,400 respectively.

**Fees prior to any early bird discount.

Please tick one of the following:

 / Early Bird Discount - as a lump sum / £2787.50 - payment to be received by 31 August 2016
 / As a lump sum / £2,950 - payment to be received by 31 August 2016
 / Payment by instalment / An initial payment of £600 to be received by 30 August 2016 followed by 10 monthly payments from Septembers 2016 – June 2017 of £267.50 made by standing order (payments by instalments are subject to a 10% surcharge)
 / Payment by employer / £2,950 (as per invoice to employer). Payment to be received by 31 August 2016
 / Payment by grant/funding / £2,950 (as per invoice). Payment to be received by 31 August 2016

Payment is preferred by electronic bank transfer:

Account number: 00083770 / Sort code: 40-52-40
Account name: The Counselling Foundation

Please reference all bank transfers with your surname.

Alternatively, please make cheques payable to The Counselling Foundation. We also accept debit and credit cards.

Payments by credit care are subject to a 2% surcharge.

If your fees are being paid by your employer please complete the information below:-

Company Name: ______

Company address______

______

Contact Name:______Telephone Number:______

DATA PROTECTION: Your details will be maintained on our electronic systems and will be used to make contact with you, to request feedback and to share information with you periodically. VIDEO: Video may be used during role play and experiential sessions for students’ own training purposes. You are deemed to consent to this unless you excuse yourself in the sessions.

I am applying for the Diploma in Psychodynamic Counselling Skills & Theory course (2016-2018) on the basis of the Course Brochure and this Application Form.

I accept that the cost of this course will be as stated above and I agree to pay this fee either in full before the course begins or in the above instalments. Should I withdraw from the course for any reason during the year, I accept that I remain liable for the whole fee for that year, and I shall settle any outstanding balance without delay. I understand that the Foundation reserves the right not to run a course if recruitment does not reach required numbers. In this event any monies paid will be refunded to me.

Signed______Print Name______

Date ______

Personal Therapy

Trainees should be with therapists who work in a way that is congruent with the psychodynamic approach, and ‘approved’ by the Counselling Foundation Training Centre.

Professional counselling provides a relationship in which clients can safely explore their experiences and become aware of hidden feelings and discover new perspectives and insights. It is partly through their own personal therapy that trainees develop the qualities required to provide this sort of relationship. Stability, personal suitability for the work and increasing emotional openness and maturity are all-important. Sustaining the counselling relationship, sometimes over a considerable period of time requires a commitment of time and energy.

Trainees must be in a minimum of once weekly psychoanalytic psychotherapy with a psychotherapist or analyst approved for training purposes by the Counselling Foundation Training Centre.

Applicants are advised to commence therapy around April at the latest, of the year of application, and no application will be considered unless there is evidence that therapy has commenced at least a month before interviews in June.

Please fill in the therapy section of the Course Application Form which contains the following information:

Qualification

  1. Advanced Diploma/Post-Graduate level and above.
  2. Evidence of at least 2yearstraining in the psychodynamic model.

Experience

  1. 3yearspost-qualifyingexperience.
  2. Currently working from a psychodynamic orientation.

Accreditation

  1. With one of the following professional bodies: BACP, UKCP (Psychodynamic Section), BPC.
  2. In future, we may obtain BPC accreditation and so any students wishing to keep their options open (in the event we do get accreditation and wish to apply for membership) should choose atherapistwho is registered withBPC.

Step 1:Search for a therapist that meets the above criteria.

Step 2:Once you have chosen a therapist contact the Training Centre* and provide us with the therapist’s name and contact details.

Step 3:We will check all the details provided and confirm that you may use the therapist.

Step 4:We will contact you to confirm approval of the therapist.

Step 5:You can now contact the therapist to confirm that you can begin working with them.

*. Tel: 01727 868585 option 6.

Therapist Form

Please enter your therapist’s details here (use BLOCK CAPITALS):

Name of Therapist ______

Address ______

______Postcode ______

______

Therapist email address ______

Name of Therapist’s Training Organisation ______

a) Date started______b) Frequency ______

Checklist of documents to be returned:

Completed and signed Application Form

A copy of your current CV

A Passport sized photograph

Your registration fee of £100.00* [This fee is non refundable]

Your deposit of £300

Your completed Equal Opportunities Form

Cheque and Standing Order Mandate Form (If applicable)

A copy of your Course Tutor Reference (external applicants only)

Your completedTherapist Form

For any queries relating to this application form, please e-mail . For queries around payment of the course fees, please e-mail .

DEADLINE FOR APPLICATIONS

Friday 20th May 2016