2017

Entry

BA(Hons) Person-centred Counselling and the Psychotherapeutic Relationship

APPLICATION FORM

PLEASE COMPLETE IN BLOCK CAPITALS AND BLACK INK

Title: / Date of Birth:
Last Name: / Age on 1 Sept 2017:
First Name(s): / Where did you hear about the Programme?
Previous Surname (if applicable):
Address: / Nationality: / Country of Birth:
How long have you lived in the UK?
Telephone: / Email:

PREVIOUS EDUCATION

Please provide details of all schools, colleges and universities you have attended (from secondary education)
Name of school/college/university: / Dates:

WORK EXPERIENCE AND RESPONSIBILITIES

Please provide details of any paid or voluntary work experience, and information regarding any responsibilities you have had at home or in the community.
Type of Work or Area of Responsibility / Dates

QUALIFICATIONS

Please list any O-levels, GCSEs or other qualifications obtained at school or college.

Exam Type (eg GCSE, GNVQ, City and Guilds) / Subject / Date / Result/Grade

TRAINING OR PROFESSIONAL QUALIFICATIONS

Please provide details of any training or professional course/qualifications you have undertaken or are doing at present, including any introductory counselling courses.

Name of Qualification and Awarding Body / Dates

REFERENCES

The Centre for Lifelong requires two references, these may be: EITHER one academic reference (from a tutor at college or someone else who has taught you in a formal setting) and one character reference (from people who know you well. You should not ask a member of your family, but an employer, colleague, or other professional person would be suitable) OR two character references.

Ask your referees to put their reference in a sealed envelope, sign over the seal, and give the reference to you. Please return your reference(s) to the Admissions Team, Centre for Lifelong Learning with your completed application form. If you are successful in obtaining a place on the programme a Disclosure and Barring Service check will be carried out.

PERSONAL STATEMENT

Please write about 500 words explaining why you would like to study for a degree. You should cover the following themes:

  • Why you have chosen this course
  • How your work or other experiences in life have prepared you for further study of this kind
  • How you can demonstrate your motivation to complete a course of Higher Education
  • Whether you have done any reading in your proposed area of study
  • Why you are interested in the Person-centred approach to Counselling and Psychotherapy
  • Special areas of interest in Counselling and Psychotherapy
  • What you intend to do, or how you will use the qualification when you have completed the course
  • The support you have from friends, family and colleagues

It would also be interesting to know about your interests and hobbies. Please feel free to include details of these in your statement.

Please continue on a separate sheet if necessary and then turn over to complete the Equal Opportunities Questionnaire and Declaration.

EQUAL OPPORTUNITIES

The University of Warwick and its partner colleges are committed to a policy of equal opportunities and will not discriminate against any applicant or student on the basis of age, gender, nationality, ethnicity or religion. Please help us to make our equal opportunities policy more effective by ticking the boxes below.

ArabAsian or Asian-British Bangladeshi

Asian or Asian British-IndianAsian or Asian British-Pakistani

Black or Black British-AfricanBlack or Black British-Caribbean

ChineseGypsy or Traveller

Mixed – White and AsianMixed – White and Black African

Mixed – White and Black CaribbeanNot known

Other Asian backgroundOther Black background

Other ethnic backgroundOther mixed background

White

GenderMaleFemale 
If you do not wish to disclose this information, please tick here 

Religious Belief

Buddhist

Christian 

Hindu

Jewish

Muslim

Sikh

Spiritual

Any other religion or belief

Information Refused

Sexual Orientation

Bisexual

Gay man

Gay woman/lesbian

Heterosexual

Other

Information Refused

PARENTAL EDUCATION

The following question is about your parents’ level of education. This includes natural parents, adoptive parents, step-parents or guardians who have brought you up.

Do any of your parents (as defined above) have any higher education qualifications, such as a degree, diploma or certificate of higher education?

Yes  No  Don’t know  Information refused 

ADDITIONAL NEEDS

We welcome applications from candidates with additional needs and consider them on the same academic grounds as those of other applicants. It is helpful to know in advance if you have any special requirements and the Senior Tutor’s Office will be pleased to help assess your needs (024 765 23761).

Are you registered disabled?YesNo

Do you have a disability/additional needs/medical condition?YesNo

If yes, please tick the relevant boxes:

Autistic Spectrum DisorderMental health difficulty

Blind/partially sightedAsperger Syndrome

Deaf/hearing impairmentPersonal care support required

Multiple disabilitiesWheelchair user/ mobility difficulties

Other disability

A specific learning difficulty, e.g. dyslexia

An unseen disability (e.g. Diabetes, epilepsy, asthma)

Other additional needs (please specify below)

DECLARATION OF CRIMINAL RECORD

The University asks all its applicants whether they have any criminal convictions. If you have a criminal record, we can still consider you for a place but the University will ask for details of the offence. Depending on the nature of the conviction, the University may give further consideration to your admission before confirming any offer. You are not required to disclose spent convictions.

Do you have any criminal convictions?YesNo

DECLARATION

Please sign and date your application to confirm that the information you have provided is accurate to the best of your knowledge.

Signed ...... Date ...... ………......

Please return your completed form to: Admissions Team (C&P), Centre for Lifelong Learning, University of Warwick, Coventry, CV4 7AL or by email to:

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