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Tavistock Relationships

PC1-A Foundation Certificate in Couple and Individual Counselling and Psychotherapy

Your Details

Forename	Surname
Title	Date of Birth
Country of Birth	Country of Permanent Residence

Contact Address

Town/City

Post Code

Mobile Phone

Have you previously applied to a TR training course?

Yes

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’.

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

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
Name of Awarding Institution	Course Duration
Result	Year of Completion/Expected Completion

Other Training Information

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

Previous Experience of Therapy

Have 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. Please also include the name of your therapist and training body if known)

Personal Statement

Please complete a personal statement in support of your application. It should include: Part 1- Your education and/or 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 300 words

Personal Statement - Part 1 Education and Professional Life

Personal Statement

Part 2 Information 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.

Please indicate if you are happy to receive information from Tavistock Relationships about our work and other trainings and events

YES - Please add me to your newsletterNO

Please indicate the type of information you are interested in

TR TrainingTR TherapyTR Together (CPD's)

You can opt in or out of this 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 £

Salesforce Data

Course Name

Product Id

Course Id

Capacity Check

Capacity Status

Available Capacity

Course Start Date

Price Status

Fee 1

Pricebook Entry Id

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