SWARTHMORE EDUCATION CENTRE
CERTIFICATE IN COUNSELLING STUDIES APPLICATION FORM
COURSE DETAILS: Please highlight course applying for
Daytime Level 3 Certificate in Counselling Studies (CST-L3) 2015 - 2016
Evening Level 3 Certificate in Counselling Studies (CST L3) 2015 - 2016
PERSONAL DETAILS
Surname:
Title:
Forename (in full):
Preferred name:
Date of birth:
Nationality:
Country of birth:
CONTACT DETAILS
Home address:
Address for correspondence (if different):
Home telephone number:
Mobile number:
E-mail address:
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PLEASE POST OR EMAIL COMPLETED APPLICATION FORM AND REFERENCES TO:
By email to counselling-app@swarthmore.org.uk
Tel: Level 3 Course Queries to Counselling Department 0113 243 7987
If you have difficulties emailing your application you can post to:
Wendy Bloom, General Admin Assistant, Swarthmore Education Centre, 2-7 Woodhouse Square,
Leeds LS3 1AD
General enquires (payment and enrolment): 0113 243 2210 Email: info@swarthmore.org.uk
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EDUCATION AND QUALIFICATIONS
School, College, University or
Dates
educational establishment
From
To
Qualifications gained or being
studied for
Date obtained
result and grade
RELEVANT COUNSELLING TRAINING
Training establishment
Level
Hours of tuition Qualifications (including
awarding body)
3
RELEVANT COUNSELLING TRAINING
Training establishment
Level
Hours of tuition Qualifications (including
awarding body)
Important note, to study at level 3 you
must have at least 75 hours studying
counselling skills at level 2, Short
introduction courses do not provide
sufficient skills training to prepare you for
this course. See
http://www.cpcab.co.uk/qualifications/cstl3
PAST EMPLOYMENT HISTORY
This section is for brief details about your past employment history. Please include any part-time, casual and
voluntary work undertaken.
Dates
From - To
Oganisation name, address and
telephone number:
Position held and brief description of duties
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PAST EMPLOYMENT HISTORY
This section is for brief details about your past employment history. Please include any part-time, casual and
voluntary work undertaken.
Dates
From - To
Oganisation name, address and
telephone number:
Position held and brief description of duties
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CURRENT EMPLOYMENT
Post title:
Date commenced:
Organisation name, address & telephone number:
Details of post:
QUESTIONS
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1.
Please describe in detail your experiences of using counselling skills.
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2.
Please outline which counselling skills you have found to be useful and why they were useful.
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3. This course focuses on the Person-Centred Approach to counselling. What do you understand
by this and why do you wish to explore this further?
4. Please discuss your own view of your present strengths and weaknesses when using
counselling skills.
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5. Please discuss your motivation for applying for this course and what you hope to achieve.
6. This course is very much about active participation in small and large groups. Please detail your
own experiences of learning in groups and your feelings about these experiences
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7. Empathising with those we find challenging is an important part of training to be a counsellor.
Write about someone you find difficult to get on with personally, describe what the problems are
and how that feels and how that relationship helps you understand yourself.
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8. Please use this space to write anything else which you would want us to know about you.
Include information such as personal qualities, life experiences, relevant experiences not referred
to elsewhere in the form. Also, include here any health or personal factors which you deem should
be known to the college when considering your application.
DECLARATION SIGNITURE
I certify that all the entries are correct and I undertake, if admitted, to observe the
regulations of Swarthmore Education Centre.
Signature …………………….…………………………………….
Date ………………………….
REFERENCES
You are required to submit references from two referees. References should reflect on any
experiences and/or qualifications shown in the application form. Please ensure that one of your
references is from a previous counselling tutor. If your tutor reference is from a current counselling
tutor at Swarthmore tutor, just write their name and on the reference sheet provided and their
reference will be sought internally.
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Reference
Note to referee: You may continue on a separate sheet if necessary. Please return your reference
to the applicant in a sealed envelope to be forwarded with their application.
Name of applicant:
Name of referee:
Post/occupation
How long have you known the applicant:
Relationship to applicant:
Address:
Telephone number:
Fax number:
E-mail
Please comment on the applicant’s personal qualities and general character.
Please comment on the applicant’s reliability, personal integrity and honesty.
Please comment on the applicant’s relationships with others / peers.
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Please comment on the applicant’s ability to work in a group / team working.
What do you regard as the applicant’s significant strengths and limitations in relation to
undertaking a certificate in counselling studies?
Additional information:
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Referee’s signature: …………………………………….………………
Date: …………………….....
Reference
Note to referee: You may continue on a separate sheet if necessary. Please return your reference
to the applicant in a sealed envelope to be forwarded with their application.
Name of applicant:
Name of referee:
Post/occupation
How long have you known the applicant:
Relationship to applicant:
Address:
Telephone number:
Fax number:
E-mail
Please comment on the applicant’s personal qualities and general character.
Please comment on the applicant’s reliability, personal integrity and honesty.
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Please comment on the applicant’s relationships with others / peers.
Please comment on the applicant’s ability to work in a group / team working.
What do you regard as the applicant’s significant strengths and limitations in relation to
undertaking a certificate in counselling studies?
Additional information:
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Referee’s signature: …………………………………….………………
Date: …………………….....
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