Application Form
To be completed by Foundation, Intermediate and Diploma Applicants

All information supplied by you to BeeLeaf will be treated in confidence and used internally for monitoring and registration purposes.

All fields to be completed or type 'none'

Title of course for which you are applying
   
Your Details
 
First name
 
Last Name
 
Date of Birth
(dd/mm/yyyy)
 
Address:
 
Telephone (day) Telephone (evening)    
   
       
Mobile Email    
   
 
Occupation
 
Do you have any special needs?
Eg Access needs, learning support, management of physical condition.
 
Professional / Academic Qualifications (post 'A'Level):
(Please name Course provider, dates and length of course)
   
Related work experience or/and experience in a responsible role with others:
   
Why do you want to enrol on this training?
   
How do you intend to use the skills that you acquire from this training in personal and professional contexts?
 
What values are important to you?
 
What are some of the beliefs that guide you?
   
Have you experienced any illnesses, accidents or physical conditions that might affect your training?
   
Do you have any history of mental health issues/mental illness/psychiatric care, substance misuse/dependency?
Because of the vocational nature of this training, we need to know this information. Please give details including dates and treatment received or write 'none' if applicable. Please also describe the support systems you will have in place to facilitate you during this training with BeeLeaf.
NB Providing this information will not prevent your Application from being successful.
 
Those Applicants who wish to progress to UKCP Registration are liable to a Criminal Records Bureau (CRB) check upon application for UKCP Registration. Results will affect Therapists working with children and vulnerable adults and those in private practice. If you have concerns or questions regarding your legal history please use the space below

Please provide the names of two referees. See prospectus for details.
   
First Referee
Name
 
Relationship to you:
 
E-mail:
 
Address
   
Second Referee
Name
 
Relationship to you
 
E-mail
 
Address

INTERVIEW

All Applicants for the Foundation and Intermediate training are usually interviewed within 3 weeks of the application being received by BeeLeaf. This takes place on the telephone and lasts for approximately 20 minutes.

Please indicate below when you are available to be called.

Day AM PM
Monday
Tuesday
Wednesday
Thursday
Friday
Number on which you can be contacted for interview

Applicants for the Diploma programme are required to attend in person for interview.
Please provide a telephone number on which we can contact you to arrange an interview

The Community for Contemporary Psychotherapy (CCP) is the official Register for BeeLeaf Institute for Contemporary Psychotherapy. All Applicants can only be accepted onto a training module, if they agree to be placed on the Register, which binds the individual to abiding by the CCP Code of Ethics. This Code has been written in accordance with BACP and UKCP Guidelines. Anybody who enrols on a BeeLeaf training becomes a Student Member of the CCP for the duration of the course, with the Membership fee being included in the cost of the training. Membership may be extended and upgraded on application and payment of a subscription fee.

I confirm that the details on this Application form are correct to the best of my knowledge. I agree to adhere to the CCP Code of Ethics.
Tick to indicate agreement