CPPD (UK) LTD
Counselling School

APPLICATION FORMS

You can apply for the BACP accredited academic courses at CPPD either by completing the online form below or by printing a form which is available by clicking here. If you wish to apply for one of our Short Courses, please print, complete and post the form which is available by clicking here.

CPPD ACADEMIC COURSE
APPLICATION FORM

Please complete the form in full scrolling down the page, typing an 'x'
in spaces where you are asked a multiple choice question. Thank you.


Name & Address

Surname/Family Name:


First Name(s):


Previous name (if changed):



Correspondence Address

Please provide an address to which any correspondence can be sent
directly to you:

House No and Rd:


Town:


City/County:


Postcode:


Tel home:


Tel work:


Mobile Number:


e-mail:



PERSONAL DETAILS

Sex: Male Female please click one

Date of birth:

Date: Month: Year:


Age on 31st August in year of entry:

Years: Months:


Country of Birth:


SPECIAL NEEDS:

Do you have a physical or sensory disability that might
in some way affect your studies at the School and/or do
you require support facilities or treatment?

YesNo please click one

If yes, please give details below:




COURSE DETAILS:

Year in which you wish to start:


Which course are you applying for?
please mark an x next to the course in which you are interested

Certificate in Counselling

Diploma in Counselling

Advanced Diploma in Counselling

Diploma in Clinical Supervision

Malta Postgraduate Diploma

Other Courses, please specify below

Other courses that I am interested in are:


We'd be interested to know how you
heard about CPPD and our courses?

Please mark an 'x' next to the source of your info about CPPD

Colleagues/Friends

Internet

Workplace

BACP

Newspaper or Journal

If it was a newspaper or journal, please give the title



Other source, please describe



ACADEMIC QUALIFICATIONS:


Examination Centre 1


Qualifications

Please enter the following information:
Date, Subject and Level and the Result



Examination Centre 2


Qualifications

Please enter the following information:
Date, Subject and Level and the Result



Examination Centre 3


Qualifications

Please enter the following information:
Date, Subject and Level and the Result



PROFESSIONAL QUALIFICATIONS:

Please enter the following information:
Description, Name & Address of Training School, Start and Finish Dates and
Number on Register (as appropriate)

Professional Qualifications:


OTHER QUALIFICATIONS:
(including your degree if appropriate)

Other Qualifications:


Results Awaited please give details:



PRESENT EMPLOYMENT:

Position held:


Name of employer:


Place of employment


Date of appointment:



PREVIOUS EMPLOYMENT:

Most recent previous employment first please:

Previous Employer 1:

Position held:


Name of employer:


Period of Employment:


Reason for Leaving:



Previous Employer 2:

Position Held:


Name of employer:


Period of employment:


Reason for Leaving:



Previous Employer 3:

Position Held:


Name of employer:


Period of employment:


Reason for leaving:



EXPERIENCE IN COUNSELLING
If you have any experience in counselling
or of working in a therapeutic environment,
please give summary details:




REFERENCES :
Please list the names and addresses of two people who you
are approaching for references. These should be a present
or previous employer and an individual of professional
standing who has known you for at least two years.

Your referees should be able to testify your suitability for the
course of study.

Reference 1
should be your previous or present employer

Reference 1: Full Name:


Reference 1: Full address:


Reference 1: e-mail address


Reference 1: Position in the organisation


Reference 2
should be an individual of professional standing who has
known you for at least two years.

Reference 2 Full Name:


Reference 2: Full address:


Reference 2: e-mail address:


Reference 2: Position in the organisation



PERSONAL STATEMENT:

Please write a concise statement of between 200-400
words. This should include something about your
formative personal and professional experiences and
any other information that you consider will be
relevant to your application. Please include your
reasons for choosing the course at this time.



DISCLOSURE:

Please disclose:

a) any criminal offences either spent or unspent, if
none please state none.



b) any disqualification from any professional organisation,
if none please state none.




DECLARATION

Please mark an 'x' in the box to confirm the following
declaration:

'I hereby declare that by submitting this form to CPPD, all
of the the information I have provided is, to the best of
my knowledge, correct and truthful.'

Full name:


Date:


When you have filled in all the relevant information, please click the 'Send' button below to submit your enquiry. All information will be held in the strictest confidence and will not be shared, transmitted or exchanged.