Training Application Form

This application form needs to be filled in for all of our counselling training courses. Once our training office has received your application form, reference forms and your application fee, we will consider your application. We cannot finalise applications until all items have been received.

Please indicate which course you are applying for:

I am applying for Introduction to Community Counselling (ICC) Certificate in Community Counselling (CCC) Introduction AND Certificate in Community Counselling Diploma in Community Counselling

Personal Details

Surname : First Name(s):

Date of Birth:

Present Address:

Post Code: Country:

Country of Birth:

Mobile Phone: Home or Work Phone:

Email Address:

Permanent Address (if different from your present address):

Post Code: Country:

Emergency Contact

Who do we contact in case of an emergency involving you?

Title: Mr. Mrs. Miss Ms.

Surname: First Name(s):

Relationship (e.g. Father, Mother, Sister, Friend etc.):

Permanent Address:

Post Code: Country:

Mobile Phone: Home Phone:

Work Phone:

Email Address:

Please indicate your proficiency in English : Elementary Speaking Limited Word Proficiency Minimum Professional Proficiency Full Professional Proficiency Native Tongue Proficiency Mother Tongue

If you have completed any of the following tests please indicate the score you received and attach a copy of your test results. E.G. Test of English as a foreign Language (TOEFL), International English Language Testing System (IELTS), Cambridge ESOL exams. If you have not taken a test we may ask you to do so.

Score:

Present Occupation / Career Details

Please list present or past work experience (paid or voluntary) beginning with the most current or send us a copy of your current CV. Please include who you worked for and when:

Education and Qualification

Please describe counselling training or experience (if any):

Please note: The Diploma in Community Counselling requires applicants to have successfully completed our Introduction to Community Counselling (Step 1) and the Certificate in Community Counselling (Step 2) or another professional counselling training in excess of 200 training hours.

Reference Forms

As part of the application process we ask you to provide two references - an academic or character reference and a reference from your pastor, YWAM school leader or employer. Your referees should know you well but should not be related to you.

Cut and copy the link to our online reference form and email the link to your chosen referees. The link will allow your referees to complete and submit the reference form online.

www.eccp-ywam.org.uk/training_reference_form.htm

Please provide the names and email addresses of the two people that will be supplying your references.

Reference 1: Academic or character reference

Surname : First Name(s):

Phone: Email address:

Surname : First Name(s):

Phone: Email address:

Background Questions

Please answer the following questions briefly.

1. Please tell us in approx. 400 words why you wish to take this course and how it might assist your future involvement in pastoral care and counselling?



2. Do you have any health problems, dietary restrictions or any disabilities that may affect your day – to – day functioning? If yes, please outline how your functioning may be limited. We may be able to offer you a range of assistance, so please describe the support or equipment that you need:


3. Have you ever been diagnosed with any mental health issues for which you have received treatment or a psychiatric referral? If yes, please give details:

4. Have you ever been cautioned, charged or convicted of a criminal offence in this or anther country, or have you any cases pending? If so, please explain.

5. Is there anything else you think we should know about you?

Declarations

• I declare that I have completed this application truthfully, to the best of my knowledge
• I understand that my application cannot be processed until reference forms and my application fee has been received

Paying your application fee (opens in a new window)

• I understand that the course I am applying for involves experiential elements that will involve some personal disclosure and associated personal development activities
• If I am accepted, I will comply with the values and ethos of YWAM Youth with a Mission (These documents are available upon request)
• I understand that in accordance with the UK Data Protection Act 1998, the information provided on my student application form will not be kept for longer than it is necessary
  
  I have read and agree with the declarations above

No Yes

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