Complete this application form when applying for the certificate in counselling theory, and forward on with the full fee

Name:             
                                           Age:                Gender:

Tel:                                                                

E-mail:                

Address:               
                      

 

Please state
any previous training in counselling,
psychotherapy or allied
subjects, if any:

 

 

 

 

 

State any
relevant previous and present work experience, or qualifications, if any?

 

 

 

 

 

 

Sates any
personal development work have you experienced,
if any?

 

 

 

 

 

 

What are
your reasons for wanting to embark on this course at this particular time in
your life?

 

 

 

 

  

 

Any other comments

 

 

 

 

 

Return to: Norman Warden,
GCS, Cnocan an Bhodaigh, Furbo, Co. Galway. Email as attachment.