TRAINEE AND VOLUNTEER APPLICATION FORM Name Email Address Telephone Mobile Secondary education Qualification Year University or College (if applicable) Qualification Year Counselling skills training Year Current (or past) counselling or psychotherapy course Year of study Experience of therapeutic work George Leach Placement manager Psychological and Counselling Services Health Centre Building University of Sussex Falmer, Brighton BN1 9RW 01273 878156 counselling@sussex.ac.uk www.sussex.ac.uk Other (relevant) work experience or information Experience, and orientation, of personal therapy What do you consider is meant by a therapeutic relationship? What qualities do you feel you have which will help with the above? Tell us what attracts you to this particular placement, and what qualities you could offer specifically to young people? Signed Date Please return to: George Leach, Placement Manager, PCS, Health Centre Building, University of Sussex, Falmer, Brighton BN1 9RW. g.d.leach@sussex.ac.uk *Whether you apply by email or complete this form by hand, please circle which of the following days/times you would be available: Monday/Thursday/Friday mornings/afternoons Tuesday/Wednesday mornings/afternoons/ evenings 2