Department of Clinical, Educational and Health Psychology
Mindfulness–Based Approaches for Working with Children
and Young People
Tuesday 23rd September – Tuesday 18th November 2014
Application Form
Course Fee: £450.00
PLEASE SELECT PAYMENT OPTION 1 OR 2 BELOW:
1) Cheque enclosed (made payable to UCL)
2) Please invoice my LA – Include purchase order number:_________________
PLEASE COMPLETE IN BLOCK CAPITALS
Applicant's Full Name ……………………………………………. Daytime Tel ...............................................
LA / Organisation………………………………………………. Post Held …………………………………………………………………….
Email address:……………………………………………………………………………………………………………………………………………..
Applicant's Contact Address …………………………………………………………………………………………..……………………………
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Invoice Address if different from above ………………………………………………………………………….………………………….
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Signed ……………………………………..……………………………………… Date …………………………….……………………………
Closing date for applications is Tuesday 9th September 2014
Applications should be sent to us by email, post or fax at:
Educational Psychology Group, UCL, 26 Bedford Way,
London WC1H 0AP
Email: edadmin@ucl.ac.uk
Fax: 020 7679 5354
(Please email us with any enquiries. Alternatively you can telephone 020 7679 5307)
Cancellation policy: If a cancellation is made on or before Tuesday 26th August 2014, then 80% of
the registration fee will be refunded. After this date, no refunds can be made.