ACT
Diploma Online Booking Form

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.

    First Name


    Surname


    Date Of Birth


    Address


    Post Code


    Mobile No


    Home Phone


    Email


    Preferred Course - please indicate


    Counselling Skills

    People undertaking postgraduate level training will normally have completed (or be completing) the COSCA Level 8 Counselling Skills Course or equivalent. Please complete on the boxes below:

    COSCA Skills

    I have completed the COSCA Counselling Skills Course: Date of Completion:

    I am in the process of completing the COSCA Counselling Skills Course:
    Date of completion expected.


    Equivalent Counselling Skills Training (e.g HNC, Degree)

    I have completed an equivalent course to the COSCA Counselling Skills Course:
    Please provide details including date of completion:

    I am completing an equivalent course to the COSCA Counselling Skills Course:
    Please provide details including date of completion


    Alternative Counselling Experience (core profession)

    If you have not completed the COSCA Counselling skills course or equivalent please tell us about alternative training and experience which may be considered as equivalent.


    Please provide information about any other qualifications, training and workplace or volunteering experience which you think supports your application:

    Please tell us a little about why you would like to become a CBT Therapist (Maximum 500 words):

    Do you have any additional support needs that may affect your training and/or placement(we will endeavour to make reasonable adjustments wherever possible?

    Please provide any additional information that may support your application (Maximum 500 words):

    Employer Details

    I confirm that the information within this application is accurate.

    Signed (a typed signature is fine):
    Date:

    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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