Practitioner Sign Up Form

Name

First Name

Last Name

Google Account Email

We use google meet for our video conferencing software needs, if you do not possess a google account, they can be made for free

Phone

Country

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GCSE Attainment

A LEVEL Attainment

Psychotherapy / Counselling Training Course (in completion, or completed)

Course Contact Details

We will only use these should you proceed onto a placement with us - we may reach out to your course provider for the completion of any paperwork associated with your placement

Relevant Vocational Experience

Hours Requirements

How many hours are required as part of the completion of your course, and/or accreditations?

Bio

Describe yourself for the purpose of your online profile

Supervision

I have a supervisor in place

I do not have a supervisor in place

Insurance

I have student professional indemnity insurance

I do not have student professional indemnity insurance

Course Tutor/Mentor/Academic Supervisor Email

We will use this to contact your courseshould your application proceed and be accepted