2016
Entry
Foundation Degree in
Person-centred Counselling and Psychotherapy
APPLICATION FORM
PLEASE COMPLETE IN BLOCK CAPITALS AND BLACK INK
Title:
Date of Birth:
Last Name:
Age on 1 Sept 2016:
First Name(s):
Where did you hear about the Programme?
Previous Surname (if applicable):
Address:
Nationality:
How long have you lived in the UK?
Telephone:
Email:
PREVIOUS EDUCATION
Please provide details of all schools, colleges and universities you have attended (from secondary education)
Name of school/college/university:
Dates:
WORK EXPERIENCE AND RESPONSIBILITIES
Please provide details of any paid or voluntary work experience, and information regarding any responsibilities you
have had at home or in the community.
Type of Work or Area of Responsibility
Dates
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QUALIFICATIONS
Please list any O-levels, GCSEs or other qualifications obtained at school or college.
Exam Type (eg GCSE, GNVQ, City and
Guilds)
Subject
Date
Result/Grade
TRAINING OR PROFESSIONAL QUALIFICATIONS
Please provide details of any training or professional course/qualifications you have undertaken or are doing at
present, including any introductory counselling courses.
Name of Qualification and Awarding Body
Dates
REFERENCES
The Centre for Lifelong requires two references, these may be: EITHER one academic reference (from a tutor at
college or someone else who has taught you in a formal setting) and one character reference (from people who
know you well. You should not ask a member of your family, but an employer, colleague, or other professional
person would be suitable) OR two character references.
Ask your referees to put their reference in a sealed envelope, sign over the seal, and give the reference to you.
Please return your reference(s) to the Admissions Team, Centre for Lifelong Learning with your completed
application form. If you are successful in obtaining a place on the programme a Disclosure and Barring Service check
will be carried out.
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PERSONAL STATEMENT
Please write about 500 words explaining why you would like to study for a degree. You should cover the following
themes:
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Why you have chosen this course
How your work or other experiences in life have prepared you for further study of this kind
How you can demonstrate your motivation to complete a course of Higher Education
Whether you have done any reading in your proposed area of study
Special areas of interest in Counselling and Psychotherapy
What you intend to do, or how you will use the qualification when you have completed the course
The support you have from friends, family and colleagues
It would also be interesting to know about your interests and hobbies. Please feel free to include details of these in
your statement.
Please continue on a separate sheet if necessary and then turn over to complete the Equal Opportunities
Questionnaire and Declaration.
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EQUAL OPPORTUNITIES
The University of Warwick and its partner colleges are committed to a policy of equal opportunities and will not
discriminate against any applicant or student on the basis of age, gender, nationality, ethnicity or religion. Please
help us to make our equal opportunities policy more effective by ticking the boxes below.
Arab
Asian or Asian British-Indian
Black or Black British-African
Chinese
Mixed – White and Asian
Mixed – White and Black Caribbean
Other Asian background
Other ethnic background
White
Gender
Male
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Female
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If you do not wish to disclose this information, please tick here
Religious Belief
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
Spiritual
Any other religion or belief
Information Refused
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Sexual Orientation
Bisexual
Gay man
Gay woman/lesbian
Heterosexual
Other
Information Refused
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Asian or Asian-British Bangladeshi
Asian or Asian British-Pakistani
Black or Black British-Caribbean
Gypsy or Traveller
Mixed – White and Black African
Not known
Other Black background
Other mixed background
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PARENTAL EDUCATION
The following question is about your parents’ level of education. This includes natural parents, adoptive parents,
step-parents or guardians who have brought you up.
Do any of your parents (as defined above) have any higher education qualifications, such as a degree, diploma or
certificate of higher education?
Yes
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No
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Don’t know
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Information refused
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ADDITIONAL NEEDS
We welcome applications from candidates with additional needs and consider them on the same academic grounds
as those of other applicants. It is helpful to know in advance if you have any special requirements and the Senior
Tutor’s Office will be pleased to help assess your needs (024 765 23761).
Are you registered disabled?
Do you have a disability/additional needs/medical condition?
Yes
Yes
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No
No
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If yes, please tick the relevant boxes:
 Autistic Spectrum Disorder
 Mental health difficulty
 Blind/partially sighted
 Asperger Syndrome
 Deaf/hearing impairment
 Personal care support required
 Multiple disabilities
 Wheelchair user/ mobility difficulties
 Other disability
 A specific learning difficulty, e.g. dyslexia
 An unseen disability (e.g. Diabetes, epilepsy, asthma)
 Other additional needs (please specify below)
DECLARATION OF CRIMINAL RECORD
The University asks all its applicants whether they have any criminal convictions. If you have a criminal record, we
can still consider you for a place but the University will ask for details of the offence. Depending on the nature of the
conviction, the University may give further consideration to your admission before confirming any offer. You are not
required to disclose spent convictions.
Do you have any criminal convictions?
Yes
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No
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DECLARATION
Please sign and date your application to confirm that the information you have provided is accurate to the best of
your knowledge.
Signed ............................................................................ Date ...............……….........................
Please return your completed form to: Admissions Team (C&P), Centre for Lifelong Learning, University of
Warwick, Coventry, CV4 7AL or by email to: CLLadmissions@warwick.ac.uk
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