APPLICATION FORM – MA/PG DIP PROFESSIONAL PRACTICE, COUNSELLING
& PSYCHOTHERAPY (Advanced Clinical Practice)
Course applied for (MA or PG Dip)
Name
Address
Telephone Number(s)
Email
Date of birth
Gender
Partnership status
Children with ages
dd/mm/yyyy
*
Are you a guardian or a primary carer?
Are you taking any medication?
Yes / No
Have you had any physical, psychiatric or emotional conditions or any
addictions for which you have treatment during the last five years?
Yes / No
Have you ever been diagnosed with a psychiatric condition?
Yes / No
Have you ever been diagnosed with a serious medical condition?
Yes / No
Do you have any special needs that could affect your participation in the
training?
Yes / No
Do you have any reason why regular attendance would be difficult?
Yes / No
Do you have a criminal record?
Yes / No
If you have answered 'Yes' to any of the questions above then please give details here
Please note that there is no discrimination intended in these questions and that it is crucial that you
answer these questions fully. Information provided will be held in confidence. If you are accepted onto
the course, it will be accessible to key training staff during your training. If you are not accepted onto the
course, this application will be destroyed.
NB These courses are postgraduate level therefore all students who do not have a first degree will need
to demonstrate that they can produce work to MA standards, either through results in previous
professional training or through equivalent training or experience.
Academic Qualifications
Highest Level Qualification
achieved (please attach the
certificate)
Starting and finishing date
From dd/mm/yyyy to dd/mm/yyyy
Name of the course provider
Relevant previous professional training
Name of the course provider
Starting and finishing date
From dd/mm/yyyy to dd/mm/yyyy
Qualification(s) achieved
(please attach the
certificates)
Relevant work experience –
Previous experience of personal therapy and growth work
Other relevant courses
completed
Relevant life experience
What accreditation do you hold
eg BACP accredited, UKCP registered or equivalent
Note although we will accept non-registered applicants on the course, in order to receive their
certificate, students need to be registered with BACP, UKCP or an equivalent approved by the Head of
Course by the time they submit their final piece of assessed work for the course.
Please provide a statement of your interest in the course and
how you believe you would benefit from it
Please provide information about your current clinical practice and your supervisory
arrangements. Please include an estimate of the number of hours of supervised clinical practice
you have undertaken as a psychotherapist/counsellor.
Note that this course is designed for students who have acquired enough clinical experience that will allow
them to reflect in depth on theory and practice.
Please supply two references – academic and personal
Please note that both of the references should be either on headed paper or printed from the
referee’s email account. Please scan your references and add them to your application
Your academic referee should be
from your current/most recent
employer or educational
establishment
Your personal referee could be a
friend, old colleague, etc
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Full name:
Post held/occupation:
Relationship to applicant:
Address:
Postcode:
Telephone:
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Full name:
Post held/occupation:
Relationship to applicant:
Address:
Postcode:
Telephone:
Email:
Support
Do you consider yourself to have a physical impairment/learning difficulty?
If yes to either, please specify the nature and advise if you have any specific requirements or if there is
anything we can do for you to support you through your studies.
How did you hear about the course?
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BACP website
Minster Centre website
Friend
Colleague
Therapy Today
Therapist
Internet research
Student
Graduate
Other – please specify
Ensure you have emailed the following items with this application:
 CV
 Personal biography
 Scanned copies of certificates/supporting documentation
 References
If your application is successful, you will be invited for an interview on one of these dates. Please
indicate if you are unable to do any of these dates. Thank you.
Interview dates - TBC
There is a £80 non-refundable interview fee, please pay by bank transfer. Find here our bank details.
Bank:
CAF Bank Ltd
Account name:
The Minster Centre
Account number:
00022778
Sort code:
40-52-40
I confirm I have transferred the £80 interview fee to the Minster Centre bank account.
____________________________________________________________________________
To the best of my knowledge all details given on this form are true and correct.
Signed:
Date:
______________________________________________________________________
All Minster Centre courses involve a high degree of experiential learning and require a degree of psychological robustness and capacity for selfreflection. The Centre reserves the right to refuse admission to applicants who we judge would not, at this time, be able to benefit from our
training or for whom it might be too disturbing.