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Tavistock Relationships - Advanced Summer School

16 - 19 July 2024

On Campus (London)

Title

Forename	Surname
Note: this will appear on your certificate

Date of Birth (DD/MM/YYYY)

Country of Birth

Contact Details

Contact Address (House Name, Number and Street Address)

Town/City	Country
Post Code

Mobile Phone

Have you previously applied to a TR training course?

Yes

Please provide details

How did you hear about this training ?

Salesforce Data

Course ID

Product ID

Course Name

Capacity Check

Capacity Status

Available Capacity

Course Start Date

Price Status

Professional Positions and Qualifications

Agency/ Institution Name

Job Title

Please provide details of your current professional position(s)

Please provide details of previous professional positions

Please provide details of your professional qualifications (please include details of any couple training/qualifications undertaken)

Relevant Past and Present Clinical Practice

What is the weekly average number of clients you see in your practice as:

Practitioner

Supervisor

Trainer

Please outline how you work, the type of clinical contact and no. of hours per week in direct clinical contact and/or supervisory contact)

Are you working with couples?

Yes No

Please describe your work. Please include information such as your experience of working with couples, the number you work with and the length they are seen for, the theoretical basis of your work, and the context (e.g. family, parenting).

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.

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