Tavistock Relationships

Diploma in Psychosexual Therapy (T3)

October 2024 Entry

Your Details

Forename	Surname
Title Country of Birth	Date of Birth (DD/MM/YYYY) Country of Permanent Residence

Contact Address (House Name, Number and Street Address)

Town/City

Post Code

Mobile Phone

Email

Have you previously applied to a TR training course?

Yes

No

Please provide details

How did you hear about this training ?

English Proficiency

Is English your first language?

YesNo

Was English the language of instruction of other degrees you have completed?

YesNo

If you answered “no” to both questions above, please provide information below on which English qualifications you hold and at which level (e.g. IELTS 7.0). In the case of applicants whose first language is not English, IELTS 6.5 or equivalent is required with a minimum score of 6 on ‘writing’.

Salesforce Info

Course Name

Product Id

Course Id

Capacity Status

Available Capacity

Course Start Date

Price Status

Fee1

Price Book Entry ID

Experience and Work

Current Employment

Current Occupation

Name of Employer

Dates of Employment

Details

Previous Employment

Please provide details of your previous work experience (including nature of your work) and dates of employment. Please include any voluntary work.

Name of Employer

Dates of Employment

Job Title/ Position Held

Details

Previous Employment

Name of Employer

Dates of Employment

Job Title/ Position Held

Details

Previous Employment

Name of Employer

Dates of Employment

Job Title/ Position Held

Details

Previous Employment

Name of Employer

Dates of Employment

Job Title/ Position Held

Details

Previous Employment

Name of Employer

Dates of Employment

Job Title/ Position Held

Details

Previous Employment

Name of Employer

Dates of Employment

Job Title/ Position Held

Details

Previous Employment

Name of Employer

Dates of Employment

Job Title/ Position Held

Details

Previous Employment

Name of Employer

Dates of Employment

Job Title/ Position Held

Details

Previous Employment

Name of Employer

Dates of Employment

Job Title/ Position Held

Details

Please tell us about any other work experience (paid or voluntary) that may be relevant to your application

Education and Training

Academic Qualification Type (E.g. BA, MA, Bsc, A-Level)	Course/Award Title
Other Qualification Type	Name of Awarding Institution
Course Duration	Result
Date of Completion/Expected Completion (MM/YYYY for example 06/2016

Academic Qualification Type (E.g. BA, MA, Bsc, A-Level)	Course/Award Title
Other Qualification Type	Name of Awarding Institution
Course Duration	Result
Date of Completion/Expected Completion (MM/YYYY for example 06/2016

Academic Qualification Type (E.g. BA, MA, Bsc, A-Level)	Course/Award Title
Other Qualification Type	Name of Awarding Institution
Course Duration	Result
Date of Completion/Expected Completion(MM/YYYY for example 06/2016

Academic Qualification Type (E.g. BA, MA, Bsc, A-Level)	Course/Award Title
Other Qualification Type	Name of Awarding Institution
Course Duration	Result
Date of Completion/Expected Completion(MM/YYYY for example 06/2016

Academic Qualification Type (E.g. BA, MA, Bsc, A-Level)	Course/Award Title
Other Qualification Type	Name of Awarding Institution
Course Duration	Result
Date of Completion/Expected Completion(MM/YYYY for example 06/2016

Academic Qualification Type (E.g. BA, MA, Bsc, A-Level)	Course/Award Title
Other Qualification Type	Name of Awarding Institution
Course Duration	Result
Date of Completion/Expected Completion(MM/YYYY for example 06/2016

Academic Qualification Type (E.g. BA, MA, Bsc, A-Level)	Course/Award Title
Other Qualification Type	Name of Awarding Institution
Course Duration	Result
Date of Completion/Expected Completion(MM/YYYY for example 06/2016

Academic Qualification Type (E.g. BA, MA, Bsc, A-Level)	Course/Award Title
Other Qualification Type	Name of Awarding Institution
Course Duration	Result
Date of Completion/Expected Completion(MM/YYYY for example 06/2016

Other Training Information

Please add below any further information/comments related to training you have completed

Psychotherapy/ Counselling Practice

Please give details of your current and previous practice. Please include number of individual, couple, relationship and psychosexual hours worked.

Name of Employer/ Self Employed

Dates of Employment

Job Title/ Position Held

Details (number of counselling and therapy hours worked and whether individual, relationship, couple, psychosexual)

Previous Experience of Therapy

Are you having, or have you previously had, any personal therapy? (E.g. counselling, psychotherapy, psychoanalysis)

YesNo

Please give details (type of therapy, dates and frequency of sessions, therapist name and training body if known)

References

Referees may be contacted prior to the commencement of the course.

Reference 1

Name

In what capacity, and for how long, has this person been known to you?

Contact Address

Email

Telephone

Reference 2

Name

In what capacity, and for how long, has this person been known to you?

Contact Address

Email

Telephone

Personal Statement - Part 1

Please complete a personal statement in support of your application. Please tell us about your education and/or your professional development and work life so far, highlighting aspects that are relevant to your interest in this course, your interest in counselling, and any career plans which you consider relevant to your application.
Max. length 500 words

Personal Statement Part 1 - Education and Professional Life

Personal Statement - Part 2

Please tell us about you and about your life so far. When describing your formative experiences, you may wish to highlight something specific about your childhood or family history, a significant personal event, a past or present relationship. Do include your reflections on these experiences. Please add any thoughts you may have about how your life experiences link to your interest in counselling and psychotherapy.

Max. length 500 words

Personal Statement Part 2 - Personal Life

Privacy

Any personal information provided in this application form will be used for the purpose of providing you with training services. You can read more about how we keep your data safe in our Privacy Notice.

I have read and agree with my information being used as outlined

YesNo

Please contact our training department on 0207 380 1975 to proceed with your application

Newsletter

We would like to keep you updated with information on Tavistock Relationships, our courses and events. Please indicate if you are happy to hear from us

You can change your preferences at any time by emailing us at privacy@TavistockRelationships.org or by unsubscribing from the email.

Application Fee

There is an application fee of £50 (non-refundable) due to be paid with the submission of this application form.

Please complete your card details and click submit to process your payment and submit your form.

Is your payment card registered to a different address than your contact address?

YesNo

Billing Address

First Name

Last Name

Address Line 1

Address Line 2

City

Postal Code

Payment Information

Name on Card

Billing Email

Credit Card Number

Expiry Date MM

Expiry Date YY

Credit Card CVV

Application Fee Due £