Application Form

Doctorate in Counselling Psychology and Psychotherapy by Professional Studies (DCPsych)

Please read the following information carefully

Entry requirements

This programme reflects a doctoral level profession and applicants are required to demonstrate that they are able to work at doctoral level.

Applicants need to have:

·  A 2:1 (or higher) degree in psychology that confers the Graduate Basis for Chartered Membership (GBC) as specified by the British Psychological Society (BPS).

AND

·  Relevant work or ‘life’ experience (e.g. volunteer/counselling roles, personal therapy etc.)

Application Process

There are three stages to the application process; submission of an application form, attendance at an Introductory Workshop and attendance at an Assessment Interview.

In the first instance applicants are encouraged to complete all sections of this application form and submit this with the required documentation outlined below:

·  Current CV

·  Copies of relevant qualification certificates

·  Two references; one academic and one personal/professional

Your application will be read by the Head of Faculty and/or Admissions Tutor to ensure that basic entry requirements have been met.

Introductory Workshop

The next stage is attendance at one of our two day Introductory Workshops. This workshop covers a range of topics that include:

The concept of integration, different theoretical models that we draw on in the training and related research issues; the integration of theory and practice and some of the challenges that a training of this kind can pose to a student. The workshop is also intended to provide participants with an experience of our ‘house style’ and philosophy of teaching and learning.

The workshop is part of the assessment process – we assess participants and also ask individuals to assess themselves against our criteria. Participants’ are also assessing the extent to which our style of training is a ‘good fit’ for their own learning style.

Please be aware that as workshop spaces can be limited you are advised to book on one of these sessions as soon as you feel you are ready to apply. Please contact Roland Michaud, DCPsych Senior Academic Coordinator for further information.

Please note that an Introductory Workshop can be attended prior to submitting references or copies of certificates. However, if you are selected to attend an Assessment Interview then a full application including these documents must be provided before you can be invited. Therefore, serious applicants are advised to submit all documentation prior to the workshop.

Please note that a payment of £265.00 is required to book a place on an Introductory Workshop. You may pay by cheque, bank transfer or Debit/Credit card (a 3% charge will be added to credit card payments). If paying by cheque please enclose this with your application (payable to ‘Metanoia Institute’). If you wish to pay by debit/credit card or bank transfer please contact Roland Michaud, DCPsych Senior Academic Coordinator, on 020 8832 3075 after submitting your application.

Assessment Interview

Following the initial application and attendance at the Introductory Workshop suitable applicants will be invited to attend an Assessment Interview that normally involves a small group discussion session plus one-to-one interviews. Interviews are typically 1-2 weeks following the workshop.

Please note: We cannot process your application if there are no references, or if other required documents are not included; do make sure, therefore, that a full application is submitted prior to interview.

If you are attending from overseas we are able to schedule your assessment interview on the Monday following the Sunday workshop date. If you wish to do this you will need to submit a full application prior to attending the workshop.

Please note that should you be invited to an assessment interview a payment of £120.00 will be required.

Please return your completed application to Roland Michaud, DCPsych Senior Academic Coordinator either via email or post:

Email:

Address: Roland Michaud, Metanoia Institute, 13 North Common Road, Ealing W5 2QB

Telephone: 020 8832 3075

The deadline for submitting a complete application is FRIDAY 24th JUNE 2016

APPLICANTS ARE ADVISED TO APPLY EARLY DUE TO THE HIGH LEVEL OF INTEREST IN THIS PROGRAMME

OFFICE USE ONLY
Met:
Mdx: M
1. COURSE DETAILS
Year applying to start in: / Introductory Workshop Date:
2. PERSONAL DETAILS
Title: / First Name(s):
Surname: / Previous Surname(s):
Home Address:
dew
Postcode: / Date of Birth:
Correspondence Address (if different):
Postcode: / Gender:
Telephone Number (Home): / Telephone Number (Work):
Telephone Number (Mobile): / Email Address:
Have you ever undertaken any previous training at Metanoia or attended an Introductory Workshop?
If YES, please state your Student/Membership Number:
3. PREVIOUS/CURRENT STUDY AT MIDDLESEX UNIVERSITY
Have you previously studied or are you currently studying at Middlesex University?
If YES, please state your Student/MISIS Number:
If you are a current student, when will you finish your current programme?
If you are a current staff member, what is you MISIS Self Service Login Number?
4. PERSONAL STATUS
Country of Birth: / Nationality (as on Passport):
Passport Number: / Passport Country of Issue:
Dual Nationality: / Were you born outside of the UK/EU?
If you were born in the UK/EU please move to section 5. Applicants not born in the UK/EU must answer the following questions:
Last date of entry to the UK/EU excluding holidays: / Have you applied for Refugee or Asylum status in the UK?
Have you been granted indefinite leave to remain in the UK? / Date Permanent Residence was granted:
Have you ever entered the UK on a visa? / Date of visa expiry:
PLEASE ENCLOSE/SCAN COPIES OF YOUR HOME OFFICE DOCUMENTATION
5.PROFESSIONAL REGISTRATIONS
Please give details below of professional registrations (e.g. BACP, UKCP, BPS):
Organisation / Registration No. / Date of first registration
6.GRADUATE BASIS FOR CHARTERED MEMBERSHIP (GBC)
Please note that GBC is a mandatory requirement. All applicants offered a place on the programme would be expected to register with the BPS prior to enrolment.
Do you have (or will you have by the start of the course) the Graduate Basis for Chartered Membership as specified by the BPS?
7.EDUCATION & QUALIFICATIONS
State most recent first, attaching copies of certificates/transcripts where possible. For international students these should be in both the original language and official English translation. Do not send original certificates. Continue on a separate sheet if necessary.
Institution Name and Address / Qualification Type / Subjects Taken / Grade Achieved / Date Awarded
Exams yet to be taken/awaiting results:
8.ENGLISH LANGUAGE QUALIFICATIONS
If English is not your first language, please give details of the most recent English language course you have taken or intend to take, and give the relevant grade/score for all components. You need to be proficient in the English language in order to succeed on this course. If you have taken an IELTS test then a minimum score of 7.0 in reading and writing is required.
Course Name / Results / Date
9.EMPLOYMENT & EXPERIENCE
List employment/voluntary experience chronologically, beginning with the most recent
Dates / Name of employer / Position / Paid/Voluntary
10.PERSONAL STATEMENT
A) Why do you wish to undertake this training course at this point in your life? What use do you intend to make of the training? Please continue on a separate sheet if necessary.
B) Please set out your own assessment of your personal strengths and attributes which you believe will assist you as a practitioner as well as the personal difficulties and/or characteristics which you believe may impede you. Please continue on a separate sheet if necessary.
11. CRIMINAL CONVICTIONS
Metanoia Institute is committed to safeguarding vulnerable adults and expects all students to share this commitment. Metanoia Institute meets the requirements in respect of exempted questions under the Rehabilitation of Offenders Act 1974. You are therefore required to detail all previous criminal convictions. Criminal records will be taken into account for course applications only where the conviction is relevant. Metanoia Institute reserves the right to carry out an Enhanced Disclosure with the Criminal Records Bureau as appropriate.
Have you ever had any criminal convictions?
Have you any criminal convictions which are not yet “spent” under the Act?
Are you involved in any cases for which details are pending?
If you have answered yes to any of the above questions, please enclose details in a separate sealed enveloped marked confidential with your name on it. Disclosed information will be handled and disposed of securely by Metanoia Institute in compliance with the Criminal Records Bureau Code of Practice, the Data Protection Act and other relevant legislation.
12. PEOPLE WITH DISABILITIES
The Disability Discrimination Act 1995 defines a person as disabled if they have “a physical or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities”.
(Some examples of impairments that meet the definition of disability under the Disability Discrimination Act 1995 are hard of hearing, partially sighted, severe back problems, arthritis, speech impairment, dyslexia, diabetes, epilepsy, asthma and cardiovascular conditions.)
Do you consider yourself to have a disability?
If yes please specify the nature of your disability and advise if you have any specific requirements in order to train at Metanoia.
13. REFERENCES
Please supply two references. The first reference should be from your current/most recent employer or academic institution. The second reference could be from another source. References from family members and friends will not be accepted.
We would prefer one professional and one academic reference, however, if you are unable to obtain an academic reference a second professional reference, or personal reference, may be used. Referees must be someone who has known you for at least two years.
Both references must be provided on separate sheets of paper, be signed at the bottom by the referee and included with this application form. References should be on headed paper and clearly show the full legal name and date of birth of the applicant.
There is no set template for references. References should reflect the applicant’s suitability for a doctoral programme.
FIRST REFEREE:
Full Name (including title): / Relationship to applicant:
Post held/occupation:
Address:
Postcode:
Telephone:
Email:
SECOND REFEREE:
Full Name (including title): / Relationship to applicant:
Post held/occupation:
Address:
Postcode:
Telephone:
Email:
14. DECLARATION
Any statements on this form which prove to be untrue or purposely misleading may cause the application to be cancelled. Furthermore if inaccuracies are highlighted at a later stage, we retain the right to retract any offer made or terminate the training contract with no refund of fees.
Declaration: I confirm that the information given in this form is true, complete and accurate. No information requested or other material information has been omitted. Under the terms of the Data Protection Act 1988 the personal information supplied by you will be treated in confidence but used internally for registering and statistical purposes. You may from time to time receive additional information or survey questionnaires.
Applicant Signature:
Date:
15. CHECKLIST
·  Complete the application form in full and sign and date the declaration above.
·  Ensure references have been completed in accordance with the instructions in section 13 and enclosed with this form.
·  Ensure a current CV, copies of relevant qualification certificates and any additional sheets used for Section 10 are enclosed with this form.
·  Enclose your cheque for £265.00 (payable to ‘Metanoia Institute’). Alternatively you can make payment by debit/credit card or bank transfer. If you wish to pay by either of these methods please contact Roland Michaud, DCPsych Senior Academic Coordinator on 020 8832 3075 after submitting your application.
·  Please note that if you are invited for an Assessment Interview there will be an additional fee of £120.00.
Please return your completed application to Roland Michaud, DCPsych Senior Academic Coordinator either via email or post:
Email:
Address: Roland Michaud, Metanoia Institute, 13 North Common Road, Ealing W5 2QB
Telephone: 020 8832 3075

3