Application for Diploma in Psychodynamic
Counselling
You may download the Application Form and return it
by post along with the processing fee.
Alternatively, you may fill in the Online
Application Form below, and post the processing fee (along with a note of your
name, address and the course for which you are applying.
Forms and Fees should be posted to:
Applications (Diploma)
The Garnethill Centre
28 Rose Street
Glasgow G3 6RE
Application Form - Diploma in Psychodynamic Counselling
The Garnethill Centre
Diploma in Psychodynamic Counselling 2012 - 2014 Application Form
Send Email To
Your Name
Your Email
Building Name / Number
Street
Area
Town / City
Postcode
Date of Birth
Telephone (work)
Telephone (home)
Telephone (mobile)
Current work situation (include voluntary work where relevant):
Relevant professional & educational qualifications & experience:
Experience of any previous or current personal therapy, and (if you wish) name of therapist:
Current Supervision - Supervisor name and qualifications
Frequency of supervision
Ratio of supervision to contract work
Please tick one or more of the following as appropriate:
COSCA qualifications
I have obtained COSCA Certificate in Counselling Skills and can provide a copy
I have completed COSCA Modules 1 & 2 and can provide verification from COSCA
These modules were completed at (name of institution)
When were modules completed (year)
Name of Course Director
APL
I have not obtained COSCA modules 1 & 2 but have completed equivalent work, for which I have documentary evidence, and I request APL. Please send me the additional application form for this.
I request APL for Modules 3 and/or 4. Please send me the additional application form for this.
Note: Possession of a COSCA Certificate in Counselling Skills gives the right of exemption from Part 1 of this Diploma (except for the Augmentation). However, in some cases it may be advisable for the applicant to repeat Module 4 here, along with the Augmentation. Please consult the Course Director.
Reasons for applying for the course. Please provide a 350-500 word statement describing your reasons for applying and how you arrived at this point.
Names, addresses and telephone numbers of TWO refererees who know your work and potential to train as a Counsellor. (Note: The first reference should be someone who has been your trainer, teacher or manager)
Referee 1 - Name
Referee 1: Building / Street No
Referee 1 - Street
Referee 1 - Area
Referee 1 - Town/City
Referee 1 - Postcode
Referee 1 - Tel No (home or business)
Note: The second referee may be a colleague who knows you personally.
