Scarborough Counselling & Psychotherapy Training Institute
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One year Gestalt Counselling Course
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Online Application Form
Personal Information
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Name
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Date of Birth DD/MM/YYYY
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Address 2
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Please select a training programme
Please select a course
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Diploma in Relational Gestalt Psychotherapy
Diploma in Relational Integrative Psychotherapy
Diploma in Relational Centred Psychotherapeutic Counselling
Diploma in Supervision
Professional Qualifications
Professional Qualifications (please indicate dates)
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Education
School/College/University
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Examinations Passed
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Dates
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School/College/University
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Examinations Passed
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Dates
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School/College/University
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Examinations Passed
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Dates
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School/College/University
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Examinations Passed
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Dates
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School/College/University
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Examinations Passed
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Dates
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Professional Experience
Nature of work
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Employer
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Voluntary
Dates
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Nature of work
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Employer
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Paid/Voluntary
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Paid
Voluntary
Dates
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Nature of work
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Employer
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Paid/Voluntary
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Paid
Voluntary
Dates
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Nature of work
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Employer
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Paid/Voluntary
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Paid
Voluntary
Dates
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Nature of work
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Employer
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Paid/Voluntary
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Paid
Voluntary
Dates
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Other relevant experience (describe & add dates)
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Personal Statements
For what reason(s) do you want to attend this training programme?
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Describe your personal strengths and attributes which you believe will help you to be a psychotherapist/ psychotherapeutic counsellor/supervisor:
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Have you received counselling or psychotherapy?
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Yes
No
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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 requesting them to return the completed forms direct to us.
Referee 1
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Referee 2
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Equality and Diversity
SCPTI is committed to working towards equality of opportunity. One of the ways in which we do this is by collecting information about the needs of our individual applicants and also about the fairness of our application process. In addition to this, SCPTI does an annual Equality and Diversity monitoring of all its members.
Although you are not required to respond to the following questions, we would like to encourage you to do. Please be aware that answering these questions is entirely voluntary and, if you choose not to complete them, this will not affect your application or training.
Do you have any learning needs that you would like to discuss with your tutor?
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Do you have any disability that you would like to discuss with your tutor?
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Are there any other aspects of diversity which you would like to note here for further discussion with your tutor? (This could include nationality & ethnicity, religion, gender, sexuality, age etc.)
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Did you feel any form of discrimination during the application process for this course?
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Yes
No
If yes, please give us more information:
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Any Additional Comments?
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How did you hear about us?
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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
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Yes
No
If YES, please specify, date of caution; bind over conviction; Court; nature of offence and sentence imposed or nature of conviction pending.
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NOTE:
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.
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 strictly 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.
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