Counselling Courses Application Form

Course

Please tick which course(s) you would like to study.

Level 2 Certificate in Counselling SkillsLevel 3 Certificate in Counselling Studies

Name/Contact Details

Physical Disability / Learning Difficulty / Health

Do you have any physical disability, learning difficulty or health problem that might affect your studies or residential needs? If so, please give details:

Emergency Contact

Education and Training

Please list details below (most recent first) of your qualifications. If you have not yet gained the award, please state in the Date of award column ’pending’.

Name of institution Dates of attendance (From) Dates of attendance (To) Qualification, subject name and awarding body Date of award

Employment / Professional Experience

Please list details below (most recent first) of your employment in the last 10 years. Please also list any professional experience relevant to your application (add additional lines if necessary).

Name & address of employer Dates (From) Dates (To) Position Held Experience Gained

Extra space:

Why the Chosen Course?

In no more than 200 words, please explain why you wish to pursue a training course in counselling?

Referees

Please give the name and contact details, preferably email address, of someone to whom we can write for a reference. N.B. We cannot accept a relative as a referee.

Criminal Convictions


YesNo

Application Fee

This course requires a £15 application fee. You can pay below, by bank transfer (details available on request), or by cheque made payable to Birmingham Christian College.
I have paid online.I have paid by bank transfer.I have sent a cheque.

Declaration



Equal Opportunities Monitoring Information

Information on ethnicity and/or disability will not be used in reaching a decision on the outcome of your application.

Ethnic Origin

WhiteBlack/British CaribbeanBlack/British AfricanBlack (Other)Asian/British PakistaniAsian/British BangladeshiAsian/British IndianAsian/British ChineseAsian (Other)White/Black CaribbeanWhite/Black AfricanWhite/AsianOtherDo not wish to specifyNot Known

If you selected 'Other' please specify:

Disabilities (tick all that apply)

AutisticBlind/Visually impairedDeaf/Hearing impairedDyslexiaOther Learning DifficultyMental Health needsMobility problemsMultiple disabilitiesUnseen disabilityOther

If you selected 'Other' please specify:

Finding out about Birmingham Christian College

How did you first learn about Birmingham Christian College (please tick)?

Internet SearchChurch/PastorFriendCurrent/Former StudentPress AdvertRadio AdvertOther

If you selected 'Other' please specify:

Additional Information

If you would like to be included on our mailing list to receive information and news about the college, special events and other courses of interest please tick this box.