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Application form for Certificate in Humanistic Integrative Counselling

Course Details:

Which course are you applying for? *

Personal Details:

Name *

Email *

Address *

Telephone

Mobile *

Emergency Contact *

Emergency Name *

Relationship to you *

Place of Birth *

Date of Birth *

Gender *

Male Female Non-Binary Transsexual Other

Qualifications:

Professional Qualification

Additional Qualifications

Employment Details:

Name of Present Employer/Organization: *

Present Position *

Date of Employment *

Address of Employer *

How did you hear about CPPD?

Experience in Counselling:

If you have any experience in counselling, or of working in a therapeutic environment, Please give a summary detail.

Do you have a physical or sensory disability that might affect your studies and/or do you require support facilities or treatment?
Please also inform us of any medication that you may be on or any allergies you have.

References: (Please give a name of a reference that has known you for at least 2 years)

Name of Referee: * Position Of Referee * Phone number of Referee * Address Of Referee * Email address of Referee *

Personal Statement

Please write a concise statement of between 200-400 words. This should include something about your formative personal and professional experiences and any other information that you consider will be relevant to your application. Please include your reasons for choosing the course at this time. Your form will not be considered unless a personal statement is submitted along with it.

Documents

Cnic Copy (Front - Back)
Passport Size Picture

CNIC Copy (Front)

CNIC Copy (Back)

Picture

Declaration

I hereby declare that all the information submitted in the form to CPPD is correct to the best of my knowledge.

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