Module 2 Direct Entrants - Application for Training

		Chichester Counselling Services	. . helping others to help themselves


		32 Little London, Chichester, West Sussex. Telephone: 01243 789200. Fax: 01243 789207

Module II Direct Entrants - Application for Training

Please print this form out, fill in the questions and return the application form to CCS at the address above, enclosing a stamped self-addressed envelope to acknowledge it's receipt, together with a £80 non-returnable interview fee and a recent passport size photograph. Please make cheques payable to 'CCS'.

Please print

Full Name...............................................................................................................Title.....................

Address (inc. postcode)......................................................................................................................
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Evening Tel:....................................................DaytimeTel:..................................................................

Date of birth:....................................................

Qualifications:......................................................................................................................................
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Previous counselling training inc. name of college, length of course........................................................
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Relevant employment/voluntary experience...........................................................................................
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Current employer and address ............................................................................................................
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Where did you hear about this course?..................................................................................................
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Please delete as appropriate:

Do you have a disability?.....................................................................................................Yes/No

Nature of disability and facilities required (unfortunately wheelchair access is not yet available)
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Do you have any psychiatric history (if so, please give details) ............................................................... ............................................................................................................................................................
Have you ever had any criminal convictions?..........................................................................................

Funding:.........................................................Self/Funded by employer/ Part funded
If funded, is written approval required?....................................................................Yes/No
Time availability to train in Module II: Morning /Evening/Either:..............................

For office use only: Date recd. SAE Int fee recd
Refs appld for: Ind int date offr Date accepted

Question 1: Why do you want to be a counsellor?
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Question 2 : Please state what you understand by the psychodynamic approach and why you prefer this model
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Question 3: Explain here your prior counselling training, outlining the skills and theory covered.
State also the precise number of hours involved in that course.
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Question 4: Qualifications obtained and date:................................................
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Question 5 : What do you expect to gain from doing this course and why are you applying for direct
entry into Module II?
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Question 6: Do you envisage any difficulties in proceeding directly into Module II?
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Question 7 : What qualities do you think a counsellor needs ? Please give examples of any situations
which would demonstrate when you have shown these qualities.
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Question 8 : Confidentiality is very important in this line of work; please give your views of this.
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Question 9 : Sometimes you have to work with people of different race, religion or sexual orientation.
How would you feel counselling/training with someone who has strongly opposing views to you?
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Question 10 : Counselling training especially at Diploma level, does change people ; how do you feel
about the prospect of personal growth and change.
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Question 11 : Have you had personal therapy ? ...................................................................Yes/No

Please give dates............................................................................................................

Was this therapy at CCS ? (please see note f ).............................................Yes/No

Should you be called for interview you will be asked to submit a tape recording of a client session or role play in support of your application and write an essay not exceeding 1000 words (typewritten please) illustrating your understanding of the psychodynamic model based on your personal journey during your first year's counselling training.

Question 12: Please write a personal history of between 800 and 1000 words highlighting key people and events in your life and how they have affected your own personal development and understanding. Please continue over the page if necessary.

Please give names and addresses of two people who would be prepared to give you a reference, one
professional (current employer if applicable), plus someone who knows you well.
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Signed........................................................................................ Date..........................................................

You may find the following information useful

a. If you require notification of your application for training, please include a stamped self-addressed envelope with your form.

b. There is no formal academic requirement, but during the training you will need to undertake, and make time for, regular theoretical reading.

c. It may be difficult to undertake this training after a recent close bereavement. This will be discussed at the interview.

d. Any past or present participation in drug/alcohol/addiction programmes do not preclude you from the training, but please inform us. It will be discussed at the interview.

e. Self development and personal therapy is an integral part of the course; please be aware that you will change and this may have a major effect on your life and relationships. This training involves your own journey of self-growth and self-awareness. Personal therapy is an integral part of this, so that you can understand and recognise what is happening within yourself. Only then can you work effectively with clients. This can be a painful process. Weekly therapy is mandatory during the second and third years, it will cost approximately £10-25 per session.

f. For reasons of confidentiality we cannot accept students who are current or recent (1year) clients at CCS.

g. Please be aware that this application is for direct entry into the second year of a three year course. Training and supervision is undertaken in groups. There will be a major time commitment, particularly in the second and third years. This will entail attending for your weekly training, and from the second year, seeing two clients weekly and attending weekly supervision. This will mean being at CCS at least two days or evenings a week, with the inevitable travel time and cost. You will also be required to attend Saturday workshops. Please read the prospectus carefully for full details.

h. Please note that the training days are different in the second and third years from the last

I. This application form and the interview process is designed to help you decide if counsellor training is for you. The next stage of the process will be an individual interview where you will have an opportunity to meet the Module I and Pastoral Care Tutor.

j. Applications usually far exceed the number of places. Unfortunately, we are not able to interview all applicants. We will inform you as soon as possible whether or not you have been selected for interview. CCS will not enter into any discussion or correspondence if your application is unsuccessful.