Leeds Institute of Health Sciences
Tel: 0113 343 6942 (Admissions enquiries)
MSc in Family Systemic Therapy 2013/15
Supplementary Information Sheet
1. PERSONAL INFORMATION
Do not include any contact details that you do not want to be used by the admissions team or
course staff. Provision of contact details is assumed consent for contact from the team if required.
NAME:
CURRENT JOB TITLE:
WORK ADDRESS:
Work Telephone No.
(please list numbers and
Work Mobile number:
extensions where messages can be left)
Personal Mobile number:
PLEASE ATTACH A PASSPORT SIZE PHOTOGRAPH HERE
2. References
Please follow instructions below rather than Section H on the University of Leeds Application For
Taught Postgraduate Study.
Only one referee should comment directly on your academic ability from your Intermediate level
Course (use Document A) and the other should be a professional reference (from your current line
manager/supervisor) (use Document B). Please ensure you give your referees the relevant
guidance notes with the documents. These references MUST be returned with this application
form. Unfortunately, we cannot process the application without them. If you experience
difficulties obtaining your references, please contact the Course Director as soon as possible.
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3. Course Fees
The cost of the course is £4,000 for academic year of 2013/2014 for home/EU students. Please
indicate how this will be funded (please tick one):
 SELF (Please note: self funding applicants may pay the course fee in two instalments: one in
September at the time of registration and the other the following January/February)
 SPONSOR (Please enclose a copy of your letter of confirmation of funding – see Document E ,
an example letter provided - and give your sponsor’s name and full address below)
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 SELF & SPONSOR (SELF_______% , SPONSOR________%, please provide letter of
confirmation of funding and use the space above to provide sponsor’s name and full address)
 APPLY FOR SHA BURSARY (It is applicable to Yorkshire & Humber SHA area employed NHS
staff only. Please complete Document D the Strategic Health Authority Funding form enclosed)
4. Current Professional Experience (specifically related to practice and work with families)
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5. Supervision – please describe your current professional supervision arrangements.
Please indicate the amount of supervision you receive, the format (e.g. direct or indirect
supervision) and the orientation of the supervision
a)
Individual supervision
b)
Group supervision
c)
Have you had any other experience of family therapy supervision of your own work? If yes
please describe this and say in what way it was useful to you.
6. Research Experience
Dates
7. Writing or Publications
Dates
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8. Family Therapy Training Courses and Study Days
Formal Family Therapy Training (Foundation, Intermediate)
Date(s)
Additional Family Therapy Conferences and Study
9. Work Context
a)
Please tell us about the degree to which your present work situation provides opportunities
to practice family therapy. What facilities are available? How will you be able to meet the
requirement of 100 hours of systemic practice per year in your agency? Will you have an
opportunity to work with qualified family therapists?
b)
How would you describe your employer’s involvement in your application? How necessary is
it for them to support your training? (e.g. for fees, time off for clinics and academic days)
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10. Personal and Professional Development
Please use this space to elaborate on your personal and professional development so far in family
therapy. Please include any family or life experiences that you consider relevant to your way of
working, or any ideas or comments you wish to share with us, about how you see the relationship
between these experiences and your professional development (Please continue on the back page if
necessary)
11. Advanced Training: What do you hope to gain from it?
a)
Clinical opportunities and supervision
b)
Theoretical and research opportunities
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12. Supervision Groups – 4 hours per week
In order to inform our early planning of the course please list times of week when you would NOT be
able to attend a weekly clinic (days/evenings). Please include any issues which may affect your
ability to travel.
13. Signature and Date
Signed:
Date:
Undertaking by applicants
By submitting this application, applicants attest to the accuracy of the information given and to their
compliance with the regulations of the University of Leeds.
Please return this application form along with the University’s APPLICATION FOR TAUGHT
POSTGRADUATE STUDY and all other supporting documents using the check list provided to
ensure that all the required documents are enclosed to:
Taught Postgraduate Admissions
17 Blenheim Terrace
University of Leeds
LEEDS LS2 9JT
.
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