Diploma Online Booking Form

You can submit your application using the form below.  Alternatively, you may prefer to download and print the application form, complete and return to us.

    Name*

    Email*

    Address

    Post Code

    Mobile No

    Home Phone

    Date Of Birth*

    Preferred Course Weekend Or Weekly

    Qualifications, Training and Experience

    Current Practice/Placement
    Please give details of your current practice base or your plans for arranging a placement which could provide 100-200 hours Face to Face CBT practice

    Previous Experience
    What previous experience of CBT, counselling or supervision do you have?

    Group/Community Experience

    Additional Information
    Please provide any additional information you feel is relevant to your application

    References
    Please supply 2 references in support of your application for the Diploma course. These may be submitted with this application, sent separately or brought to your interview. The references should attest to your personal and academic suitability for undertaking a course
    of this nature

    Most ACT Counselling Services short courses require participants to share manageable personal experiences (within safe boundaries and a group working agreement) and practice based issues.

    Get in touch

    How we use your information on this page...

    WHAT DO WE DO WITH YOUR NAME?

    We take your name in order to know who we are talking to. This will only come to us in the form of an email. For more information see our Privacy Policy here.

    WHAT DO WE DO WITH YOUR EMAIL ADDRESS?

    We use your email address so that we can reply to your query. We only use it for these purposes and do not sell this information on to any 3rd party. For more information see our Privacy Policy here.

    WHAT DO WE DO WITH YOUR ADDRESS AND POSTCODE?

    We take your address so that we can post any correspondence regarding your application. We only use it for these purposes and do not sell this information on to any 3rd party. For more information see our Privacy Policy here.

    WHAT DO WE DO WITH YOUR CONTACT NUMBER?

    We will only use this if we need to correspond with you regarding your application. We only use it for these purposes and do not sell this information on to any 3rd party. For more information see our Privacy Policy here.

    WHAT DO WE DO WITH YOUR QUALIFICATIONS, TRAINING AND EXPERIENCE INFORMATION?

    We use this information to find out what present qualifications, training and experience you have to know if you fulfil the course requirements for entry. We only use it for these purposes and do not sell this information on to any 3rd party. For more information see our Privacy Policy here.

    WHAT DO WE DO WITH YOUR CURRENT PRACTICE / PLACEMENT INFORMATION?

    We use this information to find out what current practice you are undertaking or of any placements you plan to undertake that can provide 100-200 hours of Face to Face CBT practice. We only use it for these purposes and do not sell this information on to any 3rd party. For more information see our Privacy Policy here.

    WHAT DO WE DO WITH YOUR PREVIOUS EXPERIENCE INFORMATION?

    We use this to inform us of what previous experience you have had in CBT, Counselling and Supervision. We only use it for these purposes and do not sell this information on to any 3rd party. For more information see our Privacy Policy here.

    WHAT DO WE DO WITH YOUR GROUP / COMMUNITY EXPERIENCE INFORMATION?

    We use this information to see what group and community experience that you have had that will support your application. We only use it for these purposes and do not sell this information on to any 3rd party. For more information see our Privacy Policy here.

    WHAT DO WE DO WITH YOUR ADDITIONAL INFORMATION?

    We use this additional information to inform us of anything else that may support your application. We only use it for these purposes and do not sell this information on to any 3rd party. For more information see our Privacy Policy here.

    WHAT DO WE DO WITH YOUR REFERENCES INFORMATION?

    We use these references to support your application. You must have permission from your reference provider to submit your reference. We only use it for these purposes and do not sell this information on to any 3rd party. For more information see our Privacy Policy here.

    CAN I HAVE ACCESS TO MY DATA?

    Yes, you can contact us and request this and if you wish for it to be deleted we will delete upon request. For more information see our Privacy Policy here.

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