Assessment of Prior Experience and Learning (APEL)Application Form

Before completing this form you should read the information on the Approved External Course List because that will affect how you complete the form.

This form should be completed by practitionerswho hold relevant counselling or supervision qualifications or can evidence substantial relevant experience in the workplace(UK or worldwide) gained outside of Relate and who wish to work with us. Completed applications must be submitted electronically ere they will be assessed.

We aim to give a decision within 15working days ofreceipt of your application including all supporting documents and payment. We will confirm the outcome to you and your Centre. If successful we will then ask for DBS disclosure details which your Centre will need to provide.

Please note that CVs will not be considered as part of your APEL application.

All information will be held securely and in compliance with the Data Protection Act (1998) and will be used by Relate for registering practitioners. It will only be shared with these people/institutions:

  • Relate Centres
  • Relate Scheme Managers
  • Relate National
/
  • If you are applying towork for a Relate Centre your information will be shared with your Centre Manager
  • If you are a Relate Licensed Counsellor (RLC) your information will be shared with your Scheme Manager
  • Information may be shared with Relate National for administrative, workforce development and research purposes

I agree to Relate Limited holding the information supplied in these application forms and to sharing this information with the above stake holders if necessary
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Signature Date
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Please print full name

Payment

The fee for processing an APEL application is £50.00, which includes entry onto the Relate Practitioner Directory. Please state your Centre and the address below.

Name of Relate centre to be invoiced
Address

Section 1: About you

Title + Name of Applicant including any previous names
Full address(including postcode)
Email contact:
Phone contact
Date of Birth
Gender
Ethnicity
Languages spoken (including BSL)
Individual Professional Body Membership: (i.e. BACP/UKCP/COSRT/BPS)
Professional Body Membership number:
Level of Professional Body Membership:
E.g. Registered/Accredited
Date of last renewal of membership:

Section 2: Relate Services

Please indicate which Relate service/s you wish to provide:
☐ Adult Relationship Counselling
☐ Family Counselling
☐ Sex Therapy
☐ Children under 10 Years
☐ Young People 11-18 Years
☐ Supervision (please state for which service)
☐ Adult Individual Counselling

Section 3: Pre Approved Training

Have you completed a course listed on our Approved External Course List?
Click here to select option.
Course/s name
Click here to enter text.
If you are only applying to work for one service and this is the only APEL evidence you need to provide, please go to Section 10 of this form, if not please continue with Section 4 .

Section 4: Your Qualifications

Please complete section 3 for each relevant counselling qualification.If your qualification was obtained outside of the UK you will need to provide evidence of equivalence to a comparable UK qualification.(Please provide copies of documents issued through using NARIC services )
Qualification level & title: (e.g. Diploma; Post Graduate Diploma]. / Course start date: / Course completion date: / Name of training organisation / Course Academic Validating Body:
(e.g. University) / Course Accrediting Body:
(e.g. BACP; COSRT; IFT)
Section 5:Supervised Clinical Placements
Organisation / Client groups (ind/ group etc) / Date from / Date to / Total number supervised practice hours / Total number of supervision hours – indiv/group and ratio of counselling hours to supervision

Section 6: Relevant Work Experience

Please note the work experience described below must be affirmed by third parties.
Please see section 9.
Organisation Name & address / Job Title, Roles & responsibilities / Date of service from / Dates of service to

Section 7:Continuous Professional Development(completed within last 12 months)

Course Title / Length of course / Date completed
Section 8: Supporting Statement
Please provide a short statement explaining your clinical experience in relation to the Relate services you wish to provide (no more than 500 words) in support of your application. (* Not required if you have completed an approved course)

Section 9: Confirmation of Relevant Employment Experience

Please provide confirmation from two sources. One from your currentcounselling supervisor and one from your most recent relevant employer. Evidence must be signed, dated and on headed paper. Your centre or Relate National may request a report from you current or previous clinical supervisor and/or current or previous employer.
N.B. You do not need to provide references if you already work for Relate or if you have completed a course on the Approved External Course List.

Section10: Applicant Declaration

Complaints & Refusals
Are you currently the subject of a complaint to Relate, another counselling agency or any other regulatory professional body? / Y / N
Have you ever been the subject of a complaint to Relate, another counselling agency or any other regulatory professional body where the complaint against you was upheld? / Y / N
Have you ever been refused recognition, certification or accreditation by any relevant professional body? / Y / N
Please give details if you have answered ‘Yes’ to any of the above:

I confirm that the information I have presented above is a true and accurate representation of my experience and learning:

Applicant name (in block capitals):

Applicant signature:

Date:

Application Check list

  • Completed application
  • Copies of relevant qualification certificates
  • Two forms of confirmation of Relevant Employment Experience(signed, dated and on headed paper) * only If required.
  • Relate Centre details for processing Payment

Please includeall attachments/copies of documentswith your application form and return these to

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APEL and Practitioner Directory Application Final Aug 17