APPLICATION FORM by G9Fnone

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									                                                                          FOR OFFICE USE:
                                                                          Date of Interview:
2011                                                                      Decision:
Entry                                                                     Course Selector:




       F O U N D A T I O N D E G R E E S
         A P P L I C A T I O N F O R M
COURSE TITLE:         Person-centred Counselling and Psychotherapy


PLEASE COMPLETE IN BLOCK CAPITALS AND BLACK INK
Title:                              Date of Birth:
Last Name:                                           Age on 1 Sept 2011:
First Name(s):                                       How did you learn about this course?
Previous surname (if applicable):
Address:                                             Nationality:

                                                     How long have you lived in the UK?

Telephone:                                           Email/Fax:



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.
Employer/Type of Work or Area of Responsibility                     Dates
ACADEMIC QUALIFICATIONS
Please list any O Levels, GCSEs, GNVQs, A Levels or other qualifications obtained at school or college.
Exam Type (eg GCSE, GNVQ, City                Subject                     Date                Result/Grade
and Guilds)




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 University requires either one academic reference (from a tutor at college or someone else who has
taught you in a formal setting) or two character references 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.

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 Tara Cosgrove, Centre for Lifelong Learning with your completed
application form. If you are successful in obtaining a place on the programme a Criminal Records Bureau
(CRB) 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
       Special areas of interest in Counselling & 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.

Asian                          Black                        Mixed                                              White
Indian                        Caribbean                   White with Black Caribbean                        British                 
Pakistani                     African                     White with Black African                          Irish                   
Bangladeshi                   Black Other                 White with Asian                                  Scottish                
Chinese                                                    Other mixed background                            Other White             
Asian Other                                                Other ethnic background                           Irish
                                                                                                               Traveller               

Gender                Male                 Female 

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

_____________________________________________________________________________________
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, eg dyslexia                    
An unseen disability (eg 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: Tara Cosgrove, Centre for Lifelong Learning, University of Warwick,
                                             Coventry CV4 7AL

								
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