Application Form - Postgraduate Certificate in CPD (Counselling Skills)

Course Venue: UEA, Norwich

PLEASE NOTE:

Only Submit this form if you wish to apply for Postgraduate Certificate in CPD (Counselling Skills)
This is NOT a distance learning course; you will be required to attend all sessions in person, here in Norwich.
We cannot accept an application from you if you are NOT resident in the United Kingdom.
Questions/boxes marked * are compulsory.

If you do not hold a Higher Education qualification, please use the Undergraduate Certificate application form.

Course Choice

Please indicate which course you would like to apply for*

5th January 2012 to 19th July 2012 (Taught mainly on Thursday evenings)

Personal Details

Title (Mr, Mrs, Ms, Miss, etc):*

First name(s):*

Surname:*

Date of Birth (DD/MM/YYYY):*

Nationality:*

Home Address:*

Post Code:*

Telephone (Day):

Telephone (Evening):

Email Address:

Please Note: It is helpful for us to have your telephone number(s) and/or email address in case we need to contact you urgently about your application or course.

Disabilities

The University welcomes students with disabilities and strongly encourages you to disclose any disability or medical condition which may have an impact on your studies. Declaring a disability will not affect the academic decision about your application but will help us put any individual arrangements or facilities in place for the start of the course and enable us to monitor the effectiveness of our equal opportunities and diversity policies.

Do you have a disability/special need/medical condition RELEVANT to your application?*

Yes

If YES, please provide brief details below:

Ethnicity Monitoring

The information collected will be used for monitoring purposes only and will help the University to implement equal opportunities and diversity policies. Ethnicity data will not be used when assessing your application.

Please indicate your ethnic origin*

Criminal Convictions

The University requires you to state whether or not you have a criminal conviction. You do not have to declare a conviction that is classed as spent under the terms of the Rehabilitation of Offenders Act (please consult NACRO, Citizens Advice Bureau or a solicitor if you are unsure) or for motoring offences for which a standard fine or a maximum of three points was imposed. If you declare that you have a conviction you may be asked to provide details.

Do you have a criminal conviction NOT spent under the 1974 Rehabilitation of Offenders Act?*

Yes

Highest Qualification

Please indicate your previous highest qualification (GCSEs, A' Levels, undergraduate degree etc):*

Previous Continuing Education Study

Have you previously studied with Continuing Education at UEA?*

Yes

If YES: if you know your 7 digit UEA student registration number, please enter it below:

Supporting Information

Please provide the following supporting information. This is required by the Academic Director of your course, who may contact you to discuss your application. Failure to include this information will delay your application.

Details of your occupation or any voluntary work*

Details of the opportunities to apply the learning from the course in work, voluntary work or other helping role*

Details of any relevant courses you have attended, or are enrolled on (including the name of the training provider)*

Please write at least 200 words on how the person-centred approach relates to you and your use of counselling skills*

Please write at least 200 words saying why you would like to take this course at this time in your life*

Declaration

I confirm that the information given on this form is true, complete and accurate, no information requested or other material information has been omitted, and that I have completed the application myself. I agree that I have read the relevant application notes. I undertake to be bound by the terms set out in the application form and application notes and I give consent to the University of East Anglia to process the data (given by myself) I have supplied. I accept that if I do not fully comply with these requirements the University will have the right to cancel any application and that I shall have no claim against the University (in relation thereto) with regard to this. I agree to abide by the regulations of the University.

Agree to Declaration*

Yes

Application Form - Postgraduate Certificate in CPD (Counselling Skills)

Courses in Counselling Skills and CBT for Professional Development