UK Affiliate of the Albert Ellis Institute /
APPLICATION FOR ADVANCED/ASSOCIATE CERTIFICATE IN RATIONAL EMOTIVE BEHAVIOR THERAPY AND TECHNIQUES FOR TRAINING RECEIVED FROM AFFILIATED TRAINING CENTRE
Entrance Requirements:
Advanced Certificate: The course is only open to individuals who have successfully completed an Albert Ellis Institute accredited Professional Primary Certificate in REBT.
Associate Certificate: Primary and Advanced certificates in REBT; five 20 minute recordings supervised by a Certified REBT supervisor prior to the 4 day practicum (Supervisor must inform Dr. Kristene Doyle at the Albert Ellis Institute and Dr Jason Jones at the Centre for REBT prior to registering for the practicum that participant is eligible). Lists of certified REBT Supervisors are available from the Albert Ellis Institute.
During the Practicum: Participant must bring 10 full-length (45 minute) recordings to the practicum for supervision.
Following the Practicum: In the year following, participants must have 20 recordings (ten 45 minute and ten 20 minute recordings) supervised by at least three different certified supervisors. Participants should not submit all 20 recordings at one time. The idea is to receive supervisory feedback and build upon that feedback.
When all 20 recordings are completed, participants submit their 21st ‘Golden” recording, $100.00 US, and their application for the associate fellowship certificate to Dr. Kristene Doyle for review by a member of the International Training Standards and Policy Review Committee.
ADVANCED CERTIFICATE ASSOCIATE CERTIFICATE
Name as you wish it to appear on the certificate / DateMailing address
Postcode / Email
Telephone number
Job title / Institutional affiliation
Education (highest professional degree first)
Institution / Dates / Degree
Practicum location / Name of Supervisors
The Centre for REBT at the
University of Birmingham,
School of Psychology,
Birmingham, B15 2TT UK / £495.00 / Jason Jones, Peter Trower and Richard Bennett
NOTE: Copies of educational and professional qualification certificates must accompany all registrations. Photocopies are acceptable, alternatively, scanned .pdf versions are also acceptable. Full tuition fees must accompany all registrations. Tuition fees will be refunded if the practicum is closed or if the applicant is not accepted. For Practica, full tuition will be returned for cancellations received up to fourteen days before the practicum begins, and a £100 cancellation fee will be charged for cancellations received up to seven days before the practicum begins (and no refund thereafter).
Payment details
Payment for the course can be made by credit/debit card via the University of Birmingham online shop, or we can arrange for your organisation to be invoiced. If requesting payment by invoice please allow at least one month prior to the start of the course to ensure that you have a place – invoice payments must be received prior to confirm your place on the course.
I would like to pay by credit/debit card via the online shopPlease go to www.bhamonlineshop.co.uk, then click on Conferences & Events, then choose Courses & Workshops and Other Courses from the drop-down menus.
I wish to be invoiced
Customer Purchase order number
Contact name for Invoice (e.g. manager or budget holder)
Telephone Number
Fax Number
Email Address
Address (line 1)
Address (line 2)
Address (line 3)
Address (line 4
Postcode
VAT Number
Equality and Diversity Monitoring form
The Centre for REBT, as part of the University of Birmingham adheres to its policy on equality and diversity. The following information is required for monitoring purposes and will be kept in strictest confidence.
Ethnic Origin (please indicate by a tick in the appropriate box)White / Mixed / Black or Black British
British / White and Black Caribbean / Caribbean
Irish / White and Black African / African
Any other White background / White and Asian / Any other Black background
Any other mixed background
Asian or Asian British / Other Ethnic groups / Not Stated
Indian / Chinese / Not Stated
Pakistani / Any other ethnic group / I do not wish to disclose my ethnic group
Bangladeshi
Any other Asian background
Disability Discrimination Act 2005
A person has a disability under the Disability Discrimination Act if he/she has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities. Long term means has lasted, or is expected to last, for 12 months. Do you consider yourself to be a disabled person?
Yes No I do not wish to disclose whether or not I have a disability
If answering yes, please give details of your disability below:
Please complete this form and send, along with copies of your degree certificates/professional registration to:
Debbie Horton
The Centre for REBT
School of Psychology
University of Birmingham
Edgbaston
Birmingham
B15 2TT
Please ensure that you include “School of Psychology” in the address line. Alternatively you can email the form to: