ONLINE APPLICATION

Scarborough Counselling & Psychotherapy Training Institute

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One year Gestalt Counselling Course
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Online Application Form

Please select a course *

Diploma in Gestalt Psychotherapy Diploma in Relational Centred Counselling Diploma in Integrative Psychotherapy Diploma in Supervision

* Indicates required field

Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Date of Birth DD/MM/YYYY *

Professional Qualifications (with dates) *

Education (institute/ exams passed/ dates) *

Education (continue if necessary) *

Professional Experience (include nature of work, employer, paid or voluntary and dates) *

Other relevant experience (describe & add dates) *

Personal Statements

Why do you want to attend this training programme? *

Describe your personal strengths and attributes which you believe will help you to be a psychotherapist/counsellor/supervisor:

Have you received psychotherapy or counselling? Choose One *

Yes No

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If yes, please give details *

You will need two referees, one of whom has known you for at least two years in a professional capacity. Please take responsibility for forwarding two reference forms to your referees and requesting them to return the completed forms directly to us.

Name and address of Referees and context in which known:

Referee 1 *

Referee 2 *

Equal Opportunities Questionnaire

The information you provide in this section may be stored on SCPTI computers in compliance with the Data Proctection Act. No information given will adversely influence your application.

Race & Ethnicity
The following categories are based on advice provided by the CRE (Commission of Racial Equality. Please select the category to which you belong:

Choose One *

White Black African Black Caribbean Black Other Indian, Pakistani, or Bangladeshi Chinese or South East Asia Irish

Combination of above (please state) *

Other (please state) *

b) If these categories seem inappropriate or inadequate to you, how would you wish to describe yourself? *

Disability:

Please tick if you have any of the following: *

I have a disability It is a notability disability It is a sensory disability I am on the disability register

Please give us any relevant information about your disability *

Sexual Orientation
How would you describe your sexual orientation?

Bisexual Gay/Lesbian Heterosexual Transgender Unclear Prefer not to say

Other *

Religion
Would you describe yourself as a practising member of any religion? If 'Yes', please select from the list below:

Buddhist Christian Hindu Jewish Moslem

Other *

Do you feel discriminated against in the application procedures for this course?

Yes No

Are there any comments you would like to make about this application process? *

Criminal Convictions
Have you ever been convicted, cautioned, bound over or have a conviction pending in respect of any criminal offence which is not considered spent? (see note below)

Required *

Yes No

If YES, please specify, date of caution; bind over conviction; Court; nature of offence and sentence imposed or nature of conviction pending.

Please specify *

NOTE:

1 You are advised that under the provision of the Rehabilitation of Offenders Act 1974, (Exceptions) Amendment Order 1986 a person should declare ALL convictions where working with children.

2 Disclosure of a conviction does not automatically debar applicants from consideration. The offence will only be taken into account if it is considered to be one that would make the applicant unsuitable for the type of training for which they have applied.

The information provided will be treated as stricyly confidential and will be considered only in relation to this application for training.

Declaration

By submitting this form you are declaring that all the information you have provided in the completion of this online application is correct.

Submit

Download application form HERE

Download reference form HERE

© SCPTI Ltd 2015 email: mail@scpti.co.uk
Company number 04137238 Phone: 01723 376246

Scarborough Counselling and Psychotherapy Training Institute • 1 Westbourne Grove • Scarborough • North Yorkshire • YO11 2DJ • England