VOLUNTEER COUNSELLOR APPLICATION FORM

NAME: GENDER: ETHNICITY:

ADDRESS:

POSTCODE:

Mobile No: Home Tel No:

E-mail:

1. Counselling qualifications / Training:

Education Centree.g. Guildford College, NESCOT, Metanoia, Roehampton

Start date

End date

Qualification e.g. Diploma, Degree & type eg– BA Hons or BSc, etc Masters and type eg MSc

Theoretical Approach (Include all modalities)

Awarding body e.g. Greenwich University NCFE, ABC,CPCAB, QCA, Edexcel

Professional Accrediting Body e.g. BACP, UKCP

PLEASE START WITH CURRENT / MOST RECENT EDUCATION - SEE EXAMPLE BELOWGuildford College

Sep 16

Jul 19

BA (Hons) Integrative Greenwich University

BACP

2. Details of any counselling work experience:

3. Employment Record: (starting with current or most recent)

______________________________________________________________________________________________________The Counselling Partnership is a registered charity. Registration No. 1076244

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VOLUNTEER COUNSELLOR APPLICATION FORM

4. Can you outline why you have chosen to become involved in counselling?

5. Details of any other relevant experience / voluntary work:

6. Areas of specialism in your counselling work:

7. Describe how you perceive the role of a counsellor and what particular skills you have to carry out this role:

______________________________________________________________________________________________________The Counselling Partnership is a registered charity. Registration No. 1076244

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VOLUNTEER COUNSELLOR APPLICATION FORM

8. Have you experienced any personal losses or major life events which may have had an influence on your role as a counsellor?

9. Please describe any personal therapy you may have had (the theoretical ap-proach of your therapist and dates would be helpful)

10. What do you feel is the purpose of supervision and what are your hopes and expectations of it?

11. Please describe any hobbies or outside interests you have:

______________________________________________________________________________________________________The Counselling Partnership is a registered charity. Registration No. 1076244

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VOLUNTEER COUNSELLOR APPLICATION FORM

Referees: Please give the names and e- mail addresses of two referees (not personal therapist), one of whom must be able to vouch for your counselling training/experience.

Name:

E-mail Address:

Relationship/organisation:

Name:

E-mail Address:

Relationship/organisation:

References will only be taken up once a placement has been offered.

 Additional Information:

1. Do you hold a current DBS certificate? YES/NO(Obtaining one will be at a cost to you of about £50.00)

2. Do you currently hold Professional Indemnity Insurance? YES/NO

3. Are you currently a member of a professional body? (e.g. BACP, UKCP) YES/NO

4. If yes, please specify which professional body………………………………

5. How did you find out about The Counselling Partnership? …………………………….

6. I give the Counselling Partnership permission to use my data YES/NOTo receive communications about CPD events.

The information we collect about you is in order to process your application for the placement you have applied for and also to further our charitable aims and to comply with the law. We treat your information with the utmost care and take appropriate steps to protect it. We operate a policy of non-discrimination. If you would like to find out more please refer to our Privacy Policy on our website www.thecounsellingpartnership.org

Please return completed forms by Midday on Monday 5th November 2018 to: Vanessa Wright, Clinical Services Manager: The Counselling Partnership.

By email to: info @thecounsellingpartnership.org By post to: Charities House, 1 & 2 The Quintet, Churchfield Road, Walton-on-Thames, Surrey, KT12 2TZ

______________________________________________________________________________________________________The Counselling Partnership is a registered charity. Registration No. 1076244

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