MA in Gestalt Psychotherapy

APPLICATION FORM

Personal Details

Name______

Address______

______

______

Date of Birth______

Telephone______Mobile ______

E-mail______

Do you have any medical condition we should know about?

______

______

Are you on any medication?______

______

(This information is required in case you are unwell on any of our workshops)

How did you hear about this course? (Pleasespecify where):

______

Name of 2 Referees: ______

Educational background

N.B. The tables will expand as you type

From / To / Name of Institution / Title of Award
3rd level
2nd level
Professional training courses

Please list the personal development courses/activities you have undertaken and briefly describe the impact this work has had on you.

Employment history

Dates / Employer information / Nature of work

Please say briefly why you want to train as a Gestalt therapist and describe the personal qualities and experiences which you will bring.

Irish Gestalt Centre tuition fees for courses commencing in September 2017 are :

Year 1 €4,400

Year 2 €4,400

Year 3 €4,400

Year 4 €4,400

Initial Application

Applicants should complete and return this application form accompained by an initial non refundable deposit of €100. This amount is deductible from course fees if your application is successful. All applicants will be interviewed by IGC core staff either individually or in a group setting.

Acceptance of a Place

Applicants who are offered a place will be required to confirm acceptance in writing accompained by a deposit of €1550 (this includes your registration fee of €250.00 to IT Carlow). When an Applicant has accepted a place all tuition fees, including deposits shall be fully non-refundable in all personal circumstances.

The arrangements can be made to pay the balance of fees in two instalments if necessary. Students must discuss their individual circumstances with the Course Administrator.

Additional Course Costs

There is an additional annual IT Carlow registration fee of €250.00 to IT Carlow. This registration provides you with a student card and also allows you to claim tax relief on your fees .

The training fee does not cover accommodation cost for residential workshops, cost of personal therapy or supervision.

Terms & Conditions

Tutition Fees are non-refundable in all personal circumstances. Course dates are available on the website but in exceptional circumstances might be subject to change.

Declaration

I wish to apply for the MA Course in Gestalt Psychotherapy. I have read and understood the terms and conditions above and I agree to be bound by those terms and conditions.

Signature of applicant:

Date:

1