Application Form Morley College CERTIFCATE IN COUNSELLING STUDIES: LEVEL 3 20132014

Please fill out all sections of this form by hand and return it to Ibtihal Makmahi, Humanities Department, Morley College, 61 Westminster Bridge Road, London SE1 7HT.
Surname / Family name: First name: Known as: Telephone number: Address: Postcode: Email: Title: Ms/Mr/Other Other names: Date of Birth: Mobile number:

If you have a learning difficulty (e.g. dyslexia) or a physical disability, a medical condition or mental ill health, we would like to be able to support you to achieve on your course: Do you have any medical conditions or physical disabilities that might affect your ability to attend the course and/or study?

Do you have any learning difficulties (e.g. dyslexia)

Is there anything else you would like to tell us that would help us understand how best to support you?

What childcare / family care arrangements will you need to make before undertaking this course?

How did you hear about Access to HE courses at Morley College? Course Guide I am an existing student Floodlight Hotcourses Morley College Website Friend/Relative Word of Mouth Local Press
28/05/13

Advertisement Email Other: ________________________________ (please specify)

Why do you want to undertake a Counselling course and what skills do you have to help you succeed? (minimum 200 words)..

28/05/13

It is important to think about the skills you will need in order to get the most out of your chosen course. Please read the Course Outline carefully, in particular the skill section to check the literacy you will need to start the course. During your interview process we will assess these skills and may recommend that you undertake an alternative course that will prepare you for your long term study plans. If you have any queries please contact us for more assistance. List your qualifications and include details of any courses you have attended that you feel may be relevant.

Do you have any previous experience of the subject you wish to study? (if you have attended an introductory course please say when and where.

Describe your free time activities / hobbies

As you are applying for a Counselling course you must read and complete this section. Are you currently receiving counselling? Do you currently have or have you had any mental health conditions? Have you ever been diagnosed as having Schizophrenia or Bipolar Disorder? Is there anything else we should know about your health? If so provide details below:

Please continue on another page if you need to. 28/05/13

To which ethnic group do you belong? (please tick appropriate box) Bangladeshi Indian Pakistani Other Black background Chinese Mixed White & Asian White British White Irish: White Other Any other Do not wish to supply

Other Asian background Mixed White & Black African Black African Black Caribbean Mixed White & Black Caribbean Mixed Any other

What is your first language?

STATEMENT OF COMMITMENT Regular attendance as well as reading and written work will be expected from you during these courses. You will also be expected to complete any assessments and/or exams required for your chosen course at the dates and times supplied by Morley College. Are you willing to commit yourself to this course and are you sure you have the time and financial resources to complete the course? YES NO

Have you carefully read the relevant course outline, guidance notes and this application form and are you willing to abide by the protocol outlines? YES NO

Signature________________________________________________ Date______________________________ Please note: Information you provide on this form will be used for the purpose described and will be processed in compliance with the Data Protection Act 1998. Information will be provided to the Learning and Skills Council, which is registered under the Act. The register is primarily for the collection and analysis of statistical data but it also allows the council to share information with other organisations for the purpose of detecting fraud. Further information about data protection is available on request.

28/05/13