CORK COUNSELLING CENTRETRAINING INSTITUTE

7 Father Mathew Street,

CorkCity

021 4274951

B.SC. (HONS) COUNSELLING AND PSYCHOTHERAPY

APPLICATION FORMOCTOBER 2017

Closing date for this application form: ______

1. PERSONAL DETAILS

1.1 Name______

1.2 Address______

______

1.3 Date of Birth______

1.4 Telephone ______1.5 Mobile ______

1.6 E-mail ______

1.7 Where did you hear about this course? (If magazine or newspaper please specify):

______

Full-time
Part-time

1.8 Intended mode of study (please tick)

2. TRAINING

2.1Diploma in counselling or equivalent*

2.1.1 Name of course______

2.1.2 Institution______

2.1.3 Award______

2.1.4 Start date______2.2.5 End date______

2.1.5 Main theoretical approach of Diploma course ______

______

If Diploma course was an IACP-recognised course proceed to section 3, otherwise please

complete sections 2.2 in relation to work undertaken during Diploma course.

2.2.1 Other counselling theories studied ______

______

2.2.2Developmental theoriesstudied ______

______

2.2.3 From your course work, what is your understanding of the role of relationships in counselling? ______

______

2.2.4 Number of staff-student contact hours______

2.2.5 Number of hours personal development within a group setting ______

2.2.6Number of client hours completed ______

2.2.7Location of clinical placement ______

______

2.2.8Supervision arrangements______

______

* Students who completed their training at an Institute other than Cork Counselling Centre Training Institute must provide

a)a copy of Diploma course brochure, a transcript of their marks and

b)a copy of Diploma course certificate

3. POST-QUALIFICATION

3.1 Further personal development work undertaken ______

______

______

3.2 Further professional development work undertaken ______

______

______

4. CLINICAL EXPERIENCE

4.1. Current clinical practice ______

______

4.2 Number of client hours completed post-qualification ______

4.3 Current supervision arrangements ______

______

4.4 Other relevant experience ______

______

______

______

5. PROFESSIONAL AFFILIATION

5.1.1 IACP member:YES / NO

5.1.2 Level of membership:Student / Associate / Pre-accredited / Accredited

5.2 Other professional affiliations ______

6. WELL-BEING

6.1 How do you usually care for yourself? ______

______

6.2 What current circumstances in your life will require support in order for you to complete the degree?

______

6.3 What supports have you put in place that are particular to your current personal circumstances? ______

Cork Counselling Centre Training Institute welcomes applications from people with disabilities. Training places are offered solely on the basis of merit. We encourage you to disclose any disability or medical condition in confidence. You are advised to talk to us about this information, even if you do not anticipate that additional support will be required.

6.4 Any healthissue (including mental health)______

6.5 Any current medication ______

6.6 Any disability/ specific learning difficulty______

6.5Any addictions ______

6.6 Any specific needs______

7. CRIMINAL CONVICTIONS

7.1 Please give details of any criminal convictions you have; include any which may be pending______

______

Please note: All students will be required to provide Garda Clearance before commencing clinical placement

8. PERSONAL STATEMENT

Applicants are required to enclose a 2000-word personal statement on the role of relationship in the personal and professional development and how this relates to their application. This statement should make reference to the following points:

(Max 1,500 words)

Role of relationships in your:

  • Personal development
  • Clinical practice
  • Theoretical knowledge

(Max500 words)

  • Strengths and weaknesses
  • How do you anticipate that studying at Degree level will address your needs for future development?

9. REFEREES

Applicants are required to submit 2 written references in support of their application. Onereference should be from a primary trainer involved in your Diploma course. One should be from a supervisor of your clinical practice. Please see reference form enclosed.

10. PAYMENT OF FEES

(Cheque/postal order payable to ‘The Counselling Centre')

10.1 Non-refundable application fee€100(Covers administration and assessment fee)

10.2 Training fee€4,200

Full-time

Non-refundable deposit€2,000(Payable on acceptance of training place)

Non-refundable balance€2,200(Payable by 1stSeptember 2017)

Part-time

Non-refundable deposit€2,000(Payable on acceptance of training place)

Non-refundable balance Year 1€700(Payable by 1st September 2017)

Non-refundable balance Year 2€1,500(Payable by 1st September 2018)

The training fee includesthe University Registration Fee

The training fee does not include the cost of personal counselling, supervision or personal expenditure

Please note that application fees, deposit, training fees, and University Registration Fees

are non-refundable

Please tick if you have read and understood each of the following before committing to the course:

  • This is an adult training course. As such participants will be expected to demonstrate a sufficient level of maturity to take responsibility for themselves and their own involvement in the course.

This is an experiential integrative humanistic course. As such participants will be expected to participate in training activities related to their ability to form and maintain relationships. Participants must be open to explore and engage in personal reflection, creative exercises, interpersonal dialogue, feedback, challenge, and conflict management within a training groupsetting.

  • Participants will be required to have sufficient literacy skills to allow them to complete written and verbal assignments.
  • This is an Honours Degree course based on an Integrative Humanistic Model. The course is designed to develop students’ ability to take initiative and be self-directing in their professional role. During the course, participants will be required to assume personal responsibility for their learning and have a willingness to develop and demonstrate learner autonomy. Knowledge is imparted so that it is not swallowed but rather examined, deconstructed and eventually assimilated.
  • Applicants on the course understand that they will be on the Course as students. Their supervisor will be required to enter a contract for the purposes of training with the CCCTI. The number of hours supervision to counselling work will reflect that student status.
  • The top up to degree is suitable for people who are already qualified as counsellors and for those working as post graduates towards accreditation. Applicants understand that the top up to degree course requires students to have an existing level of knowledge. Students who need to apply for first time accreditation without previous studies are directed to apply for CCCTI Diploma in Counselling Course.

Please enclose the following with your application and tick applicable box:

Completed application form
Passport sized photograph
Comprehensive curriculum vitae
2000-word personal statement
€100 non-refundable application fee
Copy of Diploma course brochure
Copy of Diploma certificate
Enclosed / 2 References (see reference form enclosed)
To be forwarded

Please note:Your training place will only be finalised on receipt of fee and two written references

Signature of applicant:______

Date:______

FOR OFFICE USE ONLY

DATE RECEIVED

PROCESSING FEE

INDIVIDUAL INTERVIEW

FINAL DECISION

CONFIRMED INTEREST

LETTER OF OFFER

DEPOSIT

BALANCE

REFERENCES

1