APPLICATION FORM: COUNSELLING TRAINING PROGRAMME AT WAVERLEY ABBEY HOUSE AND PILGRIM HALL

APPLICATION FORM: COUNSELLING TRAINING PROGRAMME AT WAVERLEY ABBEY HOUSE AND PILGRIM HALL Registered Office: CWR, Waverley Abbey House, Waverley Lane, Farnham, Surrey GU9 8EP, Registered Charity No. 294387. Registered Limited Company No. 1990308. www.cwr.org.uk Waverley Abbey College is the education division of CWR Waverley Abbey College, Waverley Abbey House, Waverley Lane, Farnham, Surrey GU9 8EP Pilgrim Hall, Easons Green, Uckfield, East Sussex TN22 5RE PLEASE USE A BLACK PEN AND WRITE CLEARLY IN BLOCK CAPITALS (Please refer to the Notes for Completing Application and Referee Form) 1. PERSONAL DETAILS Please give your name as it should appear on any documentation or certificate Title: Surname: First name(s): First name by which you prefer to be known: Gender: Male Female Address: Postcode: Country: Country of birth: Nationality: Country of permanent residence: Date of birth: / / Tel (day): Tel (evening): Mobile: Email: 2. PROPOSED STUDIES a. This application is for the academic year beginning 20 b. Proposed year of entry please indicate which year of the programme you are applying to enter: Waverley Certificate of Christian Counselling/BA Year 1 BA Year 2 BA Year 3 BA Year 4 c. Please indicate whether you prefer a residential or non-residential place: Residential Non-residential 3. REFEREES Please give the names and addresses of two people who will be supplying your references. They should be people who know you well and who have agreed to act as referees. They should NOT be a member of your family. For those who attend a church regularly, a reference from the pastor, vicar or leader is the preferred choice for the second reference. REF 1: Character or Academic Reference Name: Address: Postcode: Country: Tel: Email: REF 2: Vicar/Minister/Senior Pastor/Employer/Other Name: Address: Postcode: Country: Tel: Email: 1

4. EDUCATION AND QUALIFICATIONS Please start with the most recent qualifications. If you have not yet received your award, indicate when you expect to do so. a. Higher/Further Education Title of qualification Subject/course title Grades/ class Institution(s) Dates of attendance Award date b. Secondary Education Title of qualification Subject/course title Grades/ class Institution(s) Dates of attendance Award date c. Counselling Qualifications Title of qualification Institution(s) Duration of programme Tutor contact hours Dates of attendance Award date d. Skills Assessment Direct entry applicants only please complete this section. Did your counselling qualification include an assessment (exam conditions) of your counselling skills (do not including triplet work)? Yes Please include details below No Course title Institution Date Grade e. Professional Qualifications Professional body Type of membership (eg full/associate/accredited) Award date f. Counselling, pastoral care, clinical or other relevant experience (If you are applying on the basis of life experience include details here) Title of post Name of organisation Location/country Dates (from to) 2

5. EMPLOYMENT a. Present employment Title of post Name of organisation Location/country Dates (from-to) b. Previous employment Title of post Name of organisation Location/country Dates (from-to) 6. ENGLISH LANGUAGE ABILITY (applies to overseas applicants only) English language qualification Score/grade Date of test/exam 7. PERSONAL STATEMENT Please include your reasons for applying for this particular course and why you want to train as a counsellor. How do you think this course might assist your future involvement in pastoral care and counselling? Include any other information you consider relevant to your proposed course of study. Please continue on a separate sheet if necessary. 8. PERSONAL RECORD Do you have any criminal convictions? Yes No You must write an X in one box. Failure to do so will delay the progress of your application. 3

9. COUNSELLING QUESTIONNAIRE a. Approximately how many hours of counselling or pastoral care have you conducted over the past two years? Approximate number of hours of Pastoral care Unsupervised counselling Supervised counselling b. Do you have a current placement with a c. If you are currently counselling, do you have a counselling agency? Yes No counselling supervisor? Yes No If yes, please give details If yes, please give details Name of agency: Full name of supervisor: Contact name: Address: Address: Tel (day): Tel (evening): Email: Tel (day): Tel (evening): Email: d. Mental Health: In order to support and protect students mental health it is important that we are informed of any mental health issues you may have experienced. We may request permission from you to contact your GP or Psychiatrist. Have you ever been diagnosed with any mental health issues for which you have received treatment with medication (eg antidepressants) or psychiatric referral? Yes No If yes, please give details of disorder, treatment and duration of treatment (continue on separate sheet if necessary): 10. DISABILITIES, LEARNING DIFFICULTIES AND SPECIAL DIETS a. We aim to support students with disabilities or learning difficulties to the best of their ability. Please use the box below if you would like to record a disability, specific medical condition, or learning difficulty. b. Medical/vegetarian diet (please specify) 11. FEES Who will pay your fees? I will Tuition Fee Loan Other sponsor: Name and address of sponsor: Postcode: Tel: Email: 12. PAYMENT OF NON-REFUNDABLE APPLICATION FEE I enclose the non-refundable 50 application fee (As we are a charity, to avoid substantial credit card charges it would be preferable if you were able to pay by DEBIT card or cheque. NB There is a 3% surcharge on payments by credit card.) I enclose a cheque (payable to CWR) for OR charge to my DEBIT card OR charge to my credit card (MasterCard/Visa/Maestro accepted) Card no. Valid from / Expires / Issue no. Name as it appears on your card Signature Security no. (Last 3 digits on signature strip) 4

13. ETHNICITY (This information does not form part of the selection process) Ethnic Origin/Equal Opportunities Monitoring We are committed to providing equal opportunities for all. To assist us with our monitoring please tick the box which best describes your ethnic origin: a. Asian and Asian British Indian Pakistani Bangladeshi Other Asian background (please specify) b. Black and Black British Black Caribbean Black African Other ethnic background (please specify) c. Chinese, Chinese British or other ethnic group Chinese Other Asian background (please specify) d. Mixed and mixed British White and Black Caribbean White and Black African White and Asian Other mixed background (please specify) e. White and White British English Scottish Welsh Irish Any other background (please specify) 14. DECLARATION a. I certify that the statements made by me on this form are correct. b. I understand that, if admitted to the counselling programme, I am solely responsible to Waverley Abbey College for payment of fees. c. I understand that in signing below I agree to Waverley Abbey College processing my personal data and to the information being stored electronically within Waverley Abbey College and Roehampton University s student information system. I understand that staff will have access to my personal data and that the strict rules on security and confidentiality of data will be observed and the provisions of the Data Protection Act 1998 will apply on the use of and access to information. This consent will cover the period of my studies at Waverley Abbey College unless it is withdrawn by me in writing. Signature: Date: / / 15. CHECKLIST Please ensure that you have enclosed: A fully completed application form. One passport-size photograph of yourself with your name printed on the reverse. Copies of transcripts and/or certificates (do not send original documents). A non-refundable application fee. A photocopy of your passport. A photocopy of your current visa (if required). (If you are not an EEA national you must have indefinite or limited leave to remain in the UK.) Please note: Failure to include above items will delay the processing of your application. How did you hear about this course? Present/former CWR student CWR Bible notes Website Church Friend Mailing Exhibition (please specify which one) Advertisement (please specify publication) Other (please specify) Would you like to receive our free emails with the latest on our courses and events? Yes No (Your information will not be disclosed to any other organisation.) Please return your completed form, your photos and relevant documentation plus application fee to: Admissions Office Waverley Abbey College Waverley Abbey House Waverley Lane Farnham, Surrey GU9 8EP 5

REQUEST FOR A REFERENCE - 1 Registered Office: CWR, Waverley Abbey House, Waverley Lane, Farnham, Surrey GU9 8EP, Registered Charity No. 294387. Registered Limited Company No. 1990308. www.cwr.org.uk Waverley Abbey College is the education division of CWR Pilgrim Hall, Easons Green, Uckfield, East Sussex TN22 5RE Waverley Abbey House, Waverley Lane, Farnham, Surrey GU9 8EP TO THE APPLICANT Please pass a copy of this form to your referee after inserting your name and the details of your proposed programme of study below. Applicant s surname: Name of programme applied for: Proposed date of admission: First name(s): TO THE REFEREE The person named above is applying for admission to the COUNSELLING TRAINING programme and has named you as a referee. We should be pleased to receive your reference, which will be protected according to the Data Protection Act (1998). According to the Freedom of Information Act (2004) applicants can apply in writing for a copy of this reference. If you would like further assistance in completing this reference please contact Admissions (01252 784731; Email: registry@waverleyabbeycollege.ac.uk). Title: Full name: Address: Postcode: Tel: Email: For how long have you known the applicant? In what capacity have you known the applicant? May we contact you by telephone if necessary? Yes No It would be helpful if you could include the following information (please continue on another sheet if necessary): 1. The applicant s general character and qualities 1

2. Does the applicant display the qualities expected of a counsellor, eg the ability to listen, empathy, humility, a desire to help people with their problems? 3. The applicant s intellectual qualities, achievements and potential 4. The applicant s ability to organise his/her own time 5. The applicant s ability to manage the additional demands of study 2

6. The applicant s motivation and commitment 7. Do you support the applicant s proposed course of study? 8. Are there any other comments you would like to make? Signed: Date: Thank you for providing this reference. Please return to: Admissions Office Waverley Abbey College Waverley Abbey House Waverley Lane Farnham, Surrey GU9 8EP 3

REQUEST FOR A REFERENCE - 2 Registered Office: CWR, Waverley Abbey House, Waverley Lane, Farnham, Surrey GU9 8EP, Registered Charity No. 294387. Registered Limited Company No. 1990308. www.cwr.org.uk Waverley Abbey College is the education division of CWR Pilgrim Hall, Easons Green, Uckfield, East Sussex TN22 5RE Waverley Abbey House, Waverley Lane, Farnham, Surrey GU9 8EP TO THE APPLICANT Please pass a copy of this form to your referee after inserting your name and the details of your proposed programme of study below. Applicant s surname: Name of programme applied for: Proposed date of admission: First name(s): TO THE REFEREE The person named above is applying for admission to the COUNSELLING TRAINING programme and has named you as a referee. We should be pleased to receive your reference, which will be protected according to the Data Protection Act (1998). According to the Freedom of Information Act (2004) applicants can apply in writing for a copy of this reference. If you would like further assistance in completing this reference please contact Admissions (01252 784731; Email: registry@cwr.org.uk). Title: Full name: Address: Postcode: Tel: Email: For how long have you known the applicant? In what capacity have you known the applicant? May we contact you by telephone if necessary? Yes No It would be helpful if you could include the following information (please continue on another sheet if necessary): 1. The applicant s general character and qualities 1

2. Does the applicant display the qualities expected of a counsellor, eg the ability to listen, empathy, humility, a desire to help people with their problems? 3. The applicant s intellectual qualities, achievements and potential 4. The applicant s ability to organise his/her own time 5. The applicant s ability to manage the additional demands of study 2

6. The applicant s motivation and commitment 7. Do you support the applicant s proposed course of study? 8. Are there any other comments you would like to make? Signed: Date: Thank you for providing this reference. Please return to: Admissions Office Waverley Abbey College Waverley Abbey House Waverley Lane Farnham, Surrey GU9 8EP 3

NOTES FOR COMPLETING APPLICATION AND REFEREE FORM COUNSELLING TRAINING PROGRAMME (Please read the notes before completing the application form.) Registered Office: CWR, Waverley Abbey House, Waverley Lane, Farnham, Surrey GU9 8EP, Registered Charity No. 294387. Registered Limited Company No. 1990308. www.cwr.org.uk Waverley Abbey College is the education division of CWR Waverley Abbey House, Waverley Lane, Farnham, Surrey GU9 8EP Pilgrim Hall, Easons Green, Uckfield, East Sussex TN22 5RE This form is for those who want to apply for the BA (Hons) Counselling programme and the Certificate or Diploma of Counselling offered by Waverley Abbey College. Please remember to: write legibly and only in black ink or type read and sign the declaration form arrange for two references to be completed submit copies of transcripts and/or copies of certificates awarded to date where appropriate submit one passport-sized photo with your name printed on the back submit a photocopy of your passport if you are not an EEA national you must submit a copy of your current visa (You must have indefinite or limited leave to remain in the UK.) FAILURE TO SUBMIT ANY OF THE ABOVE WILL DELAY YOUR APPLICATION. 1. Personal Details The name that you give should correspond with the name on your birth certificate, passport or marriage certificate. This will be the name under which you will be registered and will be the form of your name that appears on any certificates. You can include a preferred name and this name will be used by staff and appear on your name badge. If any of your details change during the course of the programme you must inform the Admissions Office as soon as possible. 2. Proposed Studies b. For details of the programme, the entrance requirements and the options available please see the programme brochure. Please indicate which year of the programme you are applying to enter. For example, if you want to enter the Certificate of Christian Counselling or the BA Year 1 then you should tick the first box. If you wish to apply for direct entry to Year 2, 3 or 4 on the basis of prior learning (APL) please tick the appropriate box. c. Residential accommodation is allocated in order of the application date. 3. Referees We require two referees. It is your responsibility to contact both referees and to give each of them a copy of the reference form. We recommend that you send the request to your referees as soon as you decide to apply for the counselling programme. They should be people who know you well. Family members should not be asked to provide a reference. If possible your first referee should have known you for a minimum of three years and have some knowledge of your academic ability; however, a character reference is acceptable if this is not possible. If you attend a church, we prefer your minister or pastoral leader to provide your second reference. If you do not attend a church you may ask your employer or a person of good standing in the community. Please give the names of your referees on the application form. The completed references should be returned directly to the Admissions Office by the referees. 4. Education and Qualifications NB FAILURE TO INCLUDE ALL RELEVANT DOCUMENTS WILL DELAY YOUR APPLICATION. We are unable to process applications until references and all copies of certificates or awards, that confirm your stated qualifications, are received. We do not chase up missing documents. Please do not send original documents although we may ask you to bring them to the interview. Applications for BA Year 1 and the Waverley Cert/Dip of Christian Counselling Normal entry requirements are 2 A levels and a GCSE English at grade C or above. If you do not have formal qualifications you may be admitted on the basis of relevant life experience, i.e. self-directed study or other related experience either through paid employment, voluntary work or other activity. If you need further advice please contact the Admissions Office (01252 784731). Include copies of any certificates or awards with your application. Do not send a separate CV. a. List your most recent higher or further education qualifications first. If you have not yet received your award put PENDING in the Award date column. b. List your most recent qualifications first. Include all your A levels (or higher) awards. List your O level/gcse for English along with the grade, but other O levels/gcses do not need to be listed separately. You may simply state how many O levels/gcses you have obtained. c. Include details of the duration of your counselling programme. State the number of face-to-face tutor contact hours, including group work and supervision included in your counselling training (do not include clinical practice hours or supervision hours received during clinical practice). d. e. Complete as appropriate 1

If you are applying for entry to Year 1 based on life experience (APEL), please give as much information as possible to support your application. State any experience of counselling or pastoral care that you have gained, whether formally or informally in the workplace or in a local church or community setting. Include any documentary evidence with your application. Applications for Direct Entry to Year 2 and above Complete each part of section 4 a and b, listing the most recent qualifications first. If you have not yet received your award put PENDING in the Award date column. If you are applying for direct entry on the basis of qualifications earned previously (APL), sections c, d, e and f, are particularly important to complete. If you have completed a Certificate/Diploma of Christian Counselling with the College please enclose a copy of your certificate with your application. If your qualifications were earned outside of the College you must enclose copies of any supporting awards and the curriculum or course content. Do not send a separate CV. 5. Employment a. Give details of your current employment (if any). b. Give details of previous employment beginning with the most recent. 6. English Language Ability All students must have full command of the English language. If your first language is not English, or you have not taken your education mainly in English, you will be required to have achieved an acceptable grade or score in a recognised English language test before admission to the programme can be confirmed. Approved qualifications are as follows: GCSE/ O level grade C Cambridge Proficiency Certificate grade C Cambridge Advanced Certificate grade A British Council IELTS at least 6.5 in all sections of the test TOEFL Internet based test (IBT) score of 79-80 (you must indicate your score in each band of the test along with the overall score) TOEFL score of 550, to include the writing test at 4.0 (you must include your written score along with your overall score) LCCIEB, EFB or EFC with a second grade LCCIEB, SEFIC Intermediate with a pass grade TEEP at grade 3 Please send a copy of your award along with your application. (Do not send original documents.) Applicants without one of these qualifications, but who can provide evidence of a good academic background, may be invited to take a written or oral test/essay before admission to the programme. 7. Personal Statement You may include any information you consider relevant to support your application. You may use a continuation sheet if necessary. 8. Personal Record You must enter X in the Yes box if you have any criminal convictions, including spent sentences and cautions (including verbal cautions) and bind-over orders. You will be required to provide details if any of the above applies to you. We will send you a separate form for this purpose. You should enter X in the No box if you have not been convicted of a criminal offence or if you have been convicted of a single motoring offence for which the only penalty was a fine of not more than three penalty points. You should be aware that a Criminal Records Bureau check will be required. Failure to answer this question will delay your application. 9. Counselling Questionnaire d. We recognise that the counselling programme can be demanding and this information is required to assist us in the duty of care we have towards our students. Please include as much detail as appropriate. 10. Disabilities, Learning Difficulties and Special Diets a. Waverley Abbey College seeks to support students with disabilities and learning difficulties in accordance with the requirements of the Special Educational Needs and Disability Act (SENDA). All reasonable adjustments will be made for disabled students to allow equal access to learning opportunities and to ensure that disabled students are not substantially disadvantaged as a result of their disability. Waverley Abbey House Please note that Waverley Abbey House operates within the constraints of its Grade II* listing. Lectures are held on the first floor and bedrooms are located on the second floor. Both these floors are reached by stairs only and therefore those with significant mobility challenges may not be able to access these floors. Pilgrim Hall Pilgrim Hall is accessible for mobility-impaired students. b. Please include details of any medical or vegetarian diet that you require. We cater, where possible, for medical or vegetarian diets for the first course of lunch and evening meals (for puddings, fruit or yoghurt are provided). Gluten free bread is available. Soya milk is available, on request. Gluten free biscuits are available on request, at breaks. You are welcome to bring other essential foods with you. 11. Fees The student is liable for the whole amount of the fee agreed, whether paid by the student or a third party. Please indicate who will be paying your fees. If financial support is arranged after submitting your application you will need to provide this information before registration. If you are applying to Student Finance Company for a student loan please forward the Payment Timetable to Admissions. If you are applying for a Professional and Career Development Loan (our registration number for PCDL is REG01-21276) please forward details of the amount of your award, once approved, to Admissions. This will enable us to adjust your payment balance. 2

A 500 non-refundable deposit is payable upon acceptance of a place on the programme. The balance of fees, or the first standing order payment, is payable four weeks before the start of term. You may pay the fees in full, with a 100 discount, or you may pay by standing order. Further details can be obtained from the Admissions Office. Please see the Dates and Fee sheet for further details on liability, payment of fees and cancellation policy. Unpaid fees Students may not be permitted to continue on the programme, progress to the next year, or graduate while fees remain outstanding. 12. Payment of Application Fee The 50 application fee is non-refundable and must be included with your application. 13. Ethnicity Completion of this section on ethnicity is required to allow us to monitor over time the ethnic diversity of our intake. The information does not form part of the selection process. 14. Declaration By signing this declaration you are confirming that: a. the information given is correct and complete and that if admitted to the counselling programme, you will be subject to the regulations and disciplinary code and that you agree to abide by them; b. you understand that it is your responsibility, if admitted, to ensure that all fees are paid; c. you give us the right, under the Data Protection Act 1998, to process the information you have given, including data of a sensitive nature, for standard administrative purposes, including applications, education and training provision, and student support services. Some of the information may be included in data sent to the University of Roehampton to enable them to carry out their statutory duties under the Education Acts. 15. Checklist Please use the checklist to confirm that all sections of the application form have been completed and all items required are sent with your application. Please return your completed application to: Admissions Office, Waverley Abbey College, Waverley Abbey House, Waverley Lane, Farnham, Surrey, GU9 8EP What happens next? Once we have received your application and references we will invite you for an interview. We aim to let you know the outcome within fourteen days from the date of your interview. If you are accepted onto the programme we will require a 500 non-refundable deposit. This will secure your place on the programme. If your application is unsuccessful we will write to inform you as soon as possible. Please allow a minimum of fourteen days for us to process your application. Enquiries about your application If you would like any further information about the counselling programme or assistance in completing your application form please call the Admissions Office (01252 784731). 3