Course Booking

This application form is concerned with the training of counsellors at various levels. It is important that you consider your response to the following questions carefully as this will be used to assess your ability to commence and complete the course you are applying for.

Please contact us prior to completing the form if you have any questions about this.

    * indicates required

    Course Information

    IMPORTANT: A deposit payment is required for this course, and you will be taken to a secure payment page on completion of this form*

    Course*

     

    Your Details

    Name - This is the name that will appear on any course certification*

    Street Address*

    Town/City*

    County

    Postcode*

    Date of Birth*

    Gender*

    Email*

    Phone Number (Home)

    Phone Number (Mobile)*

     

    Emergency Contact

    Emergency Contact - Name*

    Emergency Contact - Number*

    Emergency Contact - Relationship to you*

     

    Criminal Offences

    Have you ever been convicted of a criminal offence?*

    NB – any issues arising will be discussed individually. If you have answered ‘YES’ then please give details below

    Details of any criminal offence

     

    Health

    Please list any physical or mental health conditions that you experience
    Please list including current use of medication

     

    Other Information

    Please advise any other information that may affect your learning, or you feel we would need to take into consideration
    Please see question regarding computer literacy below

    Do you consider yourself to be computer literate*

    If you answer No to this question then please include an idea of the support you may require in the box above

    Do you have any previous counselling qualifications*

    Are you currently enrolled at another college/training centre*

    If you have answered yes to any of the above three questions please provide details

     

    Referral Route

    How did you hear about Devon Counselling College*

    Social Media/Other

     

    Declarations

    Data Protection Statement
    Data Protection Act 2018 – Devon Counselling College are registered under this act and assure you that at no time will your information be passed to other organisations for marketing or sales purposes. View Privacy Statement

    Declaration 1 - To the best of my knowledge, the information in this application is correct and, having been provided with comprehensive information about the course content, I do not know of any reason why I cannot complete a course of this nature*

    Declaration 2 - I give my consent to Devon Counselling College for collecting, processing, storing and disclosing the data in this application for the purpose of enrolment, equal opportunity monitoring and administration purposes*

    Declaration 3 - I have read and agree with the Terms & Conditions (Link can be found below)*

    Terms and Conditions
    The link to Devon Counselling College's Terms and Conditions can be found here - Terms & Conditions

     

    Signature

    Please attach copy of Signature or type your name in the below box

    Only jpg, jpeg, gif or png allowed - max file size 250 kb

    Type name to agree to the above declaration if you cannot or have not attached a copy of your signature above

    On submission you will be taken to a page where you will be able to pay the deposit for the course, once your deposit is received your place on the course will be secured, space permitting. If you cannot make this payment online please contact us directly on 01626 333 346 to discuss options after completing the application form.