Advanced certificate

Application form

Name

Address

Postcode

Date of birth

Email address

Phone number

Mobile phone number

Who is paying your fees?

Phone number

Professional qualifications (please avoid abbreviations)

Counselling/Psychotherapy (including dates and approximate number of hours)

Number hours counselling in past 12 months

Membership of professional body(ies) in the country in which you practise

Professional Indemnity (how much cover?)

Which Code of Ethics do you work to?

How would you describe your familiarity with computers and the internet?
1 = not familiar, 2 = know a little, 3 = fairly competent and 4 = competent

1. 2. 3. 4.

How did you hear about this course?

What is your main interest in taking this course?:

Any special needs it would be useful for us to know about?

When do you wish to begin (General Cert. only) September or April?

Name and contact details of one referee.
(This could be your supervisor or someone else who knows you professionally).

Please Note that we have a FINAL DATE for admission: We need time to process your application, allocate you a tutor, put you in a small course group and update our website. The final date for admission to our courses is TWO WEEKS before it is due to start.

In order for your application to be processed you will need to complete these 3 steps.

Send completed Application Form by clicking the 'Submit' button below (if you have any problems with this, please copy and paste the completed form and submit by clicking here.
Send a deposit of £50 (deductible from the full fee). Cheques should be made payable to Counselling Online Ltd. If you live outside the UK or do not use cheques, you can use PayPal or enquire about bank transfer arrangements (see Fees and Payments page).
Send a one page CV and copies of your counselling qualifications and your professional indemnity. These can either be scanned into a computer and sent by email file attachment or mailed to the address below.

Anne Stokes
Admissions Tutor
Counselling Online Ltd
Rainich, North Waltham
Near Basingstoke
Hampshire, RG25 2BL.

Important Note

Fees need to be paid in full before the beginning of the course. As soon as the full fees are received you receive a password which will allow you access to the Campus website. It is helpful to familiarise yourself with the Campus website before the course starts. You can access the Library and browse through some of the online reading material. There is also help available from the tutorial staff if you have problems.


Please see below before submitting your completed form
NB Depending on your PC's operating system, when you click the 'submit' button you may be asked if you want to send this information and therefore to reveal your email address to the recipient. Do not be alarmed; this is a standard security alert. Please click 'ok' and then 'send'. In some browsers, e.g Safari, the completed form will appear as an email, which you will need to send in the usual way.