Chichester Counselling Services - Application for Training form

Chichester
Counselling
Services . . helping others to help themselves
32 Little London, Chichester, West Sussex.
Tel: 01243 789200 Fax: 01243 789207

Application for Training

Please print out this application form, complete in black ink and return the form to CCS at the address above. Enclose with the form a stamped self-addressed envelope to acknowledge its receipt.

Please print clearly

Surname .........................................................................................
Forename(s) .....................................................................................

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

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

Current Employer
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Have you ever had any criminal convictions? YES/NO
If Yes, please supply brief details in an accompanying note

Please give names and addresses of two people who would be prepared to give you a reference, one professional and someone who knows you well.

Professional
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Personal ...............................................................................................................................................
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Which course are you applying for?

Certificate
Diploma
Diploma - Direct Entry

(Please delete the courses that don't apply)

Where did you hear about this course?...................................................................................................
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Some of the questions have been worded openly. We hope that this creates a space for you to include those things which you feel relevant or important to your application

Question 1: Why do you want to be a counsellor?
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Question 2: Please summarise in note form your achievements, skills and experiences since leaving school

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Question 3 : What qualities do you think a counsellor needs
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Question 4: Confidentiality is very important in this line of work. Please give your views.
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Question 5: 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?

Question 6 : Counselling training does change people ; how do you feel about the prospect of personal
growth and change?
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Question 7: Why are you applying for this course now?
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Question 8 : Have you ever experienced personal therapy? If 'yes', please give dates.

Question 9 : Have you ever experienced psychiatric care? If 'yes' please give dates.

Question 10 : NOT FOR DIRECT ENTRANTS
On separate paper please write a personal history of between 800-1000 words, highlighting key people and events in your life and how they have affected you.

DIRECT ENTRANTS ONLY
Please ignore Question 10 and answer Questions 11,12 and 13, and note instructions under Direct Entrants additional requirements

Question 11: DIRECT ENTRANTS ONLY
Please give details of other counselling training ( including dates)
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Question 12: DIRECT ENTRANTS ONLY
Please give details of any relevant experience
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Question 13: DIRECT ENTRANTS ONLY
Please state what you understand by the psychodynamic approach
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DIRECT ENTRANTS Additional requirements

Please write a 1000 word essay illustrating your understanding of the psychodynamic model, based on your personal journey and insights gained during you first year's counselling training.
Please submit a tape recording of a role play session with a client - minimum 30 minutes

You will be asked to submit copies of your first year's reports from Course Tutors

Please return to

Chichester Counselling Services
32 Little London, Chichester, West Sussex.

For office use only:

Date recd.
Refs appld for:
Ind int date offr
Date accepted