CPCAB Level 4 - Application Form (2022 Intake)

CPCAB LEVEL 4 IN THERAPEUTIC COUNSELLING (Year 1 & 2)

Please ensure you answer all questions to prevent delay to your application
Which course are you applying for? *
1. Important Information

Please read carefully
Please complete this form clearly submit your non-refundable deposit of £200. Account link/bank details can be found below.

Please pay: Eve Therapy training & Counselling Services Ltd

Account No: 60931480

Sort Code: 60-83-71

The fees for the CPCAB Level 4 Diploma are £3,800 payable in year 1 and year 2 (£7,600 - Year1 & 2 inclusive)

(The yearly course fee is made up of £3,411 tuition fee, £339 examination fee and £50 Administration Fee)

Once accepted, If you wish to pay in instalments after you have paid your deposit, you will need to complete our online direct debit form. We do not accept payment via standing order or Bank Transfer only Direct Debit.

Important: there is no automatic registration to year 2 and is wholly dependent upon successful completion of assessed work and full payment of year 1 fees.

Please note: All tuition and exam fees are due on enrolment. However, instalment arrangements can be made for courses over £200 and scheduled for longer than 1 term. You will still be liable for all unpaid fees, even if you begin a course and decide to withdraw or fail to attend. All unpaid fees will be referred to our debt agency. By completing this and submitting this form, you accept that failure to pay your course fees (and interest incurred) in full will result in a delay to final assessment results, certification, references etc.

*PLEASE NOTE: You must have the CPCAB Level 3 Certificate in Counselling Studies (or equivalent) to enrol on this course.
2. Course Details
Which Course are you applying for *
How did you hear about this course? *

Search Engine Friend CPCAB Facebook Twitter Website Other (please specify)
Are you currently studying or have studied Level 3 with Eve Therapy Training & Counselling Services? *

Yes No
If yes, has your tutor recommended you for Level 4 in Counselling? *

Yes No Not Sure
If the anwer is 'no' or 'not sure', please do not complete this application. Please make an appointment to see your tutor.
3. Personal Details
Title *
Name: *

First Name Last Name
Birth Date *

Month Day Year
Address: *

Street Address

Street Address Line 2

City Region

Postal / Zip Code
Email *
example@example.com
National Insurance Number: *
Gender: *
Phone Number: *
4. Emergency Contact (Next of Kin)
Emergency Contact Name: *

First Name Last Name
Emergency Contact Relationship: *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Emergency Contact Number: *
5. Residency and Nationality
Nationality *
Have you lived in the UK for life? *
If you have answered No to the question above, how long have you lived in the UK for?

0-6 months 1- 2 years 3 - 5 years 5+ years
Your first language is: *
Are you an asylum seeker/Refugee? *
Do you depend on a visa or other permission to reside in the UK? *
What is the expiry date of your visa/permission? (if applicable)
6. Education
Please tick your highest level of qualification or education *

Entry Level 1 ((Fewer than 5 GCSEsA-C) Level 2 (5 GCSEs A-C) Level 3 (NVQ3, 2 Alevels) Level 4 (Certificateof Higher Education, NVQ4) Level 5 (FoundationDegree) Level 6 (BachelorDegree, Graduate Certificate and Diploma) Level 7+ (MastersPhD, Postgraduate Certificate and Diploma) No Qualifications Other
It you ticked 'other', please briefly describe the course and level of study.
GCSE English Grade *
GCSE Maths Grade *
7. Counselling Qualifications and/or Experience

Please provide details of your CPCAB Level 3 Certificate in Counselling Studies (or equivalent).
Where did you study? *
Tutor name? *
Date Level 3 Passed?
If not yet passed leave blank
Qualification name? *
Please state level and awarding body i.e Level 3 in Counselling Studies
Awarding body (e.g. CPCAB/NCFE/City & Guilds)? *
8. Learning & Support Needs
Do you have a disability/learning difficulty or a problem with your health? *
If YES, please choose the appropriate statement that applies *
If YES, please indicate below the nature of your learning difficulty, disability or health problem and indicate which problem you believe could most impact your learning) This will help us to understand how best to support you. *
Have you previously received special consideration for examinations? (E.g. extra time): *

Yes No
How would you like to let us know what additional support you are likely to need?
By talking confidentially to a member of staff *

Yes No
Through someone else such as an advocate *

Yes No
Others:
9. Employment Status

Which of the options in the list below will accurately reflect your employment status prior to enrolment at EVE Therapy Training?
In paid employment *

Yes No
If so, are you self employed? *

Yes No
And for either is your work: *

0-10 hours per week 11-20 hours per week 21-30 hours per week 31+ hours per week
If you are not in paid employment, looking for work and available to start work –how long have you been unemployed for? *

1 – Less than 6months 2 – 6-11 months16-19 3 – 12-23 months 4 – 24-35 months 5 – 36 months or over
Have you been in full time education or training just prior to enrolling? *

Yes No
10. Household Information
Which of the options in the list below reflects your household? *

No household member is in employment and the household includes one or more dependent children No household membe ris in employment and the household does not include any dependent children I live in a single adult household with dependent children None of the above apply I do not wish to give this information
(This information is required for monitoring purposes only)
11. Health & Well-Being
Please tick the appropriate box. *

I consent to my answer to this section to be disclosed to the Course Tutor(s) for the purposes of assessing my application. I understand that this information is required for my application to be considered. Listening/counselling training places a significant mental, emotional and sometimes spiritual demand on course participants. In order to help us assess your suitability to undertake this training, and to consider your needs, please answer the following questions. It is important to add; that failure to disclose could result in not being being able to provide you with the necessary support.
Do you have any mental health issues which the course core tutor should be aware of? *

Yes No Not sure
If you answered, 'not sure', please give further details.
Have you ever had personal counselling? *

Yes No
How long were you attending personal counselling? *

Never Up to a month 2-6 months 6-12months Over a year
What type of therapy was it? *

Talking therapies on the NHS Cognitive behavioural therapy (CBT) Interpersonal Therapy (Psychodynamic/ Person Centred) Eye movement desensitisation and reprocessing (EMDR) Systemic Family Therapy Couples Therapy Other - please give details below
Details:
Are you currently receiving any ongoing medical or psychiatric care? *

Yes No
Have you ever been diagnosed with a common mental health issue e.g. depression, anxiety etc.? *

Yes No
Have you ever been diagnosed with a complex mental health disorder? e.g. schizophrenia or Dissociative Identity Disorder etc *

Yes No
Have you experienced any recent or childhood trauma? *

Yes No
Do you require any additional learning or access support? *

Yes No
Do you have any specific physical needs that we should be aware of? *

Yes No
Comments: If you have answered ‘yes’ to any of the above questions, please use this space to share anything relevant with us; all information will be treated with respect and confidentiality. If you have additional needs, please specify these (continue on a separate sheet if necessary).
Answering ‘yes’ to any of the above questions does not disqualify you from applying for this course. However, in order to ensure that this course is appropriate for you we may ask you for further information.
Additional information

You are required to:
- Complete 40 hours of personal therapy (approx. £35 - £45 per hour - Student Rates).
  Obtain BACP student membership,
- Pay the required fee for your DBS certification,
  Participate in Continuous CPD activities offered internally or externally totally 50 hours per year;
  Work towards 100% attendance rate but a minimum of 80% as required by CPCAB
- Not use the course as a substitute for personal therapy
We do not accept applications from partners and those in close relationships

If you are working with children or adolescents (up to age 17) you will be able to count up to 30 hours towards the 100 hours total. This counselling will need to be provided within an agency setting and within a service framework that includes both a line manager and clinical supervision.

Personal development: You will be required to arrange and complete forty sessions of personal counselling; comprised of 20 sessions in year one and 20 sessions in year two. However, we strongly remain in counselling throughout the course.
12. Criminal Conviction(s)

Please ensure you complete this section fully
Do you have any relevant, unspent criminal convictions? *

Yes No
You only need to tell us about some specific convictions. Please read the guidelines below carefully to see if you need to let us know about ‘relevant’ and ‘unspent’ convictions.

‘Relevant’ convictions means convictions for offences:
- Against the person, whether of a violent or a sexual nature.
- Involving the unlawful supply or use of controlled drugs or substances where the conviction concerns commercial drug dealing or trafficking.
If you are applying for a course in teaching, health, social, sport, childcare or involving work with children or vulnerable adults then you must disclose any criminal convictions, cautions (including verbal cautions) and bind over orders, including spent convictions.

If you declare that you have a conviction, you will be asked to provide further information. This is to help us access any potential risks to yourself or others in the Centre and/or in your counselling placement. Having a criminal record will not necessarily prevent you from studying at the Centre but will depend on the nature of the course and the circumstances and background of the offence.

If you do not disclose a relevant conviction, then this could result in exclusion or disciplinary action by the EVE Therapy Training & Counselling Services Ltd.
Name

First Name Last Name
Student Signature *

Clear
Date: *

Month Day Year
Date
13. Personal Statement
This is your opportunity to write your own personal biography using the space below. Please include life events and work experiences that have been important for you and have impacted your awareness and responses to developing self awareness, difference and diversity and your personal understanding of counselling theory when applied to your life experiences. Please also use the space below to outline your reasons and motivation for wanting to join this course. (maximum 1500 words) *

0/1500
PLAGIARISM STATEMENT
I certify that this personal statement is my own work, based on my personal
study and/or research and that I have acknowledged all material and sources
used in its preparation, whether they be books, articles, reports, lecture notes,
and any other kind of document, electronic or personal communication. I have not copied in part or whole or otherwise plagiarised the work of other students and/or persons.
Name

First Name Last Name
Date

Month Day Year
Date
Signature

Clear
14. References
Referee 1
Name: *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Referee 2 (Level 3 Academic Tutor)
Name: *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
*Other - please specify
IMPORTANT

Please be advised, that Eve Therapy Training will make contact your referee's directly, so it is important, that you apply in good time before the start of the academic year. We will not offer places until satsifactory references are recieved.
15. Consent
I consent for my Course Portfolio and the information contained therein to be available to CPCAB for verification purposes. I understand this is a requirement for the course and should I not consent, I will NOT be offered a place on the course.

I consent I do not consent
I consent for my name, contact telephone and email address to be included on a list of course participants provided to the rest of the training group *

I consent I do not consent
I consent for EVE Therapy Training & Counselling Services Ltd to include me in photographs during the training sessions *

I consent I do not consent
I consent for EVE Therapy Training & Counselling Services Ltd to use such images in their printed and online publicity, social media, website and advertising material *

I consent I do not consent
We may wish to contact you at times with regard to details of other courses taking place at EVE Therapy Training Centre or our offsite venues, please tick the appropriate boxes to indicate if and how you would prefer to be contacted via: - *

By post By phone By email None
Privacy statement
16. Student Declaration

This must be signed
I confirm that the information given in this form is true, complete and accurate and that I have not altered this form in any way, which may prejudice my application.

I am aware, that should I provide false information, I will be:
- Withdrawn from course, if the course has not yet commenced and I will forfeit my £600 deposit fee.
- If the course has started: I will with be withdrawn from the course and will be responsible for any outstanding fees.
- That I will not be eligible for a refund
Name *

First Name Last Name
Date *

Month Day Year
Date
Signature *

Clear
17. Student Terms & Conditions

Please your learning agreement carefully and sign.
RIGHTS AND OBLIGATIONS OF THE STUDENT

1.0 Payment of Fees

THE FEES PAYABLE BY THE STUDENT (“THE FEES”) ARE MINIMUM AMOUNTS AND INCLUDE

* Costs are defined as examination or registration fees related to the main course. Materials fees may also be payable for some courses.

1.14 Course fees shall be payable in advance of commencement of the course. Payment by invoice will incur a £25 administration fee.

1.15 Principal liability for payment of the Fees shall at all times lie with the Student. In the event that a third party has actually paid the fees in full on behalf of the Student, Eve Therapy Training & Counselling Services Ltd may at any time require that the Student personally make payment of all or any part of the Fees not paid by a third party. In particular (but not so as to limit the generality of the foregoing) the Centre may so require in situations where any third party has agreed to pay all or any part of the Fees on behalf of the Student and fails in fact to make such payment within eight weeks of commencement of the Course.

1.16 In the event that course fees remain unpaid, the centre reserves the right to:
- Suspend all assessment of student course work, including tutorias and/ or support services
- To suspend transfer to higher level courses and/or progression to year 2 of the Level 4 Diploma in Counselling or Coaching
- Retain academic certificates until fees and penalties are paid in full.
- Withhold student academic/personal references
- To suspend attendance in class and/or course residentials
1.17 Where a student has failed to meet the necessary academic deadlines and where further assessment is required outside the set course dates; Students will be required to pay a fee of £30 per each peice of course work outstanding and in need of assessment.

1.18 Where a student is required to resit the CPCAB external assessment, students will be expected to pay the CPCAB resit fee of £235 and Eve Therapy Training invigilator costs of £30 per hour.

1.19 Where a student wishes to appeal, following a 'non proficient' CPCAB external assessment, the student will be expected to pay CPCAB the appeal fee of £339 plus administration costs of £30 per hour to Eve Therapy Training.

2.0 Refund of Fees

2.1 Refunds can only be given in the following cases:-

· Course Cancellation: If the Centre cancels the course at any point before or during the course, the Centre will automatically refund the tuition fee.
- Exceptional Circumstances: If a student has to leave a course due to exceptional circumstances, and is able to supply supporting evidence, pro-rata refunds may be considered. Exceptional circumstances are adjudged by the Director of School and include health, maternity and employment grounds. The complaints procedure can also be used if a student wishes to request a refund on quality grounds.
2.2 All dates stated are calculated from the date of written notification from the student of withdrawal from the course.

2.3 Only the tuition fee element of the learner fee can be reimbursed by the Centre.

2.4 Costs that have been incurred by the Centre in enrolling a student, e.g. examination costs, registration fees and purchased materials cannot be reclaimed by the student, even if they withdraw from the course, unless the course is closed by the Centre. Only the tuition fee element of the student fee can be reimbursed as per the refund policy. Administration fees are non-refundable.

3.0 Administrative Provisions

3.1 Admission to classes is conditional upon the Student producing proof of fees being paid.

3.2 Students should retain the copy of their learner agreement/receipt and their Terms and Conditions, which may be required at any time by the Centre for identification purposes.

3.3 The Student shall notify the Centre without delay of any change in the details provided by the student on the face of the enrolment form.

3.4 The Student may not change courses.

4.0 Academic Regulations

4.1 The Student shall attend all classes, tutorials and examinations, which form part of the Course. In the event of a genuine reason for absence the Student must notify his or her personal tutor immediately. In the event of absence on medical grounds of more than one week the Student must provide a Medical Certificate.

4.2 Attendance at all classes, tutorials and examinations shall be punctual.

4.3 The Student shall be deemed by the Centre to have withdrawn from the Course in circumstances where: 4.3.1 The Student is absent from a part-time programme and attendance falls below the minimum 80% attendance rate required by the centre and CPCAB.

4.4 The Student shall submit all work in line with deadlines dates, which is required as part of the Course in accordance with the deadlines set by the Centre. Failure to submit work in accordance with centre requirements will mean automatic suspension from the course.

4.5 The Student shall endeavour to complete all work required as part of the Course to a standard which is acceptable to the Centre.

4.6 The Centre shall not be obliged to mark or consider any work submitted by the Student where the Student fails to comply with the provisions of Clause 4.4 or Clause 4.5, and in the event of a persistent failure to comply with such provision the Student may be required to withdraw from the Course.

4.7 Where a student is deemed to have withdrawn from the Course under the provisions of Clause 4.3 or is required to withdraw under the provision of Clause 4.6, the student shall not be entitled to any refund of the Fees and shall pay any outstanding Fees forthwith.

4.8 Where the Centre provides the Student with equipment or books relating to the Course (and for the avoidance of doubt the Centre shall be under no obligation to make such provision), the Student shall return all such equipment and books to the Centre before the end of the academic year, or at the date of leaving if the Student leaves early, and in a similar state of repair to when they were received by the Student. The Centre reserves the right to charge Students for lost or damaged equipment.

5.0 General Regulations

5.2 The Student is expected to behave at all times in a manner which does not adversely affect in any way the legitimate use of the Centre or its facilities by any other person, which does not cause damage to the Centre property or injury to other students or staff of the Centre, which does not prejudice the effective provision of the Course by the Centre and which does not bring the Centre into disrepute.

5.3 The Student shall be subject to the disciplinary procedures of the Centre (details of which are available from the Student Services Receptions) where the Student is in breach of any of these Conditions.

5.4 The Student shall indemnify the Centre against any loss or expense incurred by the Centre as a result of breakages, losses or damage caused by the Student to any equipment or the fabric, structure or fixtures and fittings of the Centre buildings.

5.5 The Centre lifts are only for use by persons with mobility impairment.

5.7 The Student shall not place any advertisement on the Centre premises without the specific written permission from the Centre.

5.8 The Student shall not engage in gambling on the Centre premises.

5.9 Students shall not use a mobile phone in teaching and learning areas or in examinations.

6.0 Health and Safety Regulations

6.1 Students have a legal duty to take care of their own health and safety and that of other students, and the Student: 6.1.1 Shall at all times take all reasonable steps to discharge this duty; and 6.1.2 Shall comply at all times with the specific Health and Safety requirements and policy determined by the Centre (whether or not such requirements and policies are made in accordance with statutory provisions); and 6.1.3 Shall not interfere with, damage or misuse any item or equipment which has been provided by the Centre for the purposes of Health and Safety.

6.2 The Student must report forthwith to a Centre member of staff any accident, which takes place on Centre premises of which the student is aware and which results in any personal injury or damage to Centre property whatsoever.

6.3 The Student shall be responsible for the provision of protective clothing (as may be specified by the Centre) suitable for any class which takes place in any hazardous environment (including all creative workshops). The Centre reserves the right to refuse the Student entry to any such class where the Student is not wearing protective clothing.

6.4 If the Student is suffering from any infectious disease, or has been in contact with a person whom the Student knows to have been suffering from an infectious disease, the Student, in order that the health of all students and staff at the Centre may be protected shall: 6.4.1 Not enter the Centre premises; or when informing his or her personal tutor of his or her absence pursuant to Clause 4.1, also notify the personal tutor that the Student is suffering from an infectious disease and specify the disease.

6.5 If the Student is disabled, and/or has a learning disability or a medical condition, the Student is requested to inform the Centre at the time of enrolment.

6.6 The Student shall observe the Centre smoking policy and may smoke only outside the centre. The use of e-cigarettes is not permitted in and around Centre buildings.

6.7 Students should not be under the influence of drink or drugs at any time whilst on Centre premises.

RIGHTS AND OBLIGATIONS OF THE CENTRE

7.0 Services to be Provided

7.1 The Centre shall use its reasonable endeavours to provide the Student with an educational service, which shall include the following: 7.1.1 A course of classes (and tutorials) designed to prepare the Student for any examination or vocational qualification for which they have registered as a Student.

7.2 Where the number of students studying on the Course falls below a level which in the reasonable opinion of the Centre is necessary for the Course to continue, the Centre reserves the right to cancel (subject to the provisions of Clauses 2.1 and Clause 2.2), suspend or merge the course, or to deal with it in any other way which the Centre believes to be appropriate.

7.3 The Centre shall not be bound to offer the Student any particular number of classes per week, not to deliver the Course by any particular method and shall be entitled at any time to alter the timetable of the Student, to increase or decrease the number of classes relating to the Course and to alter the methods by which the Course is delivered.

8.0 Library Items inc. DVDS, CDs and Off-Air Recordings

8.1 The Student agrees to be responsible for all items lent to them and to observe the rules of the library service.

8.2 The Student agrees to adhere to the terms of the Centre ERA Licence and relevant Copyright law and accepts full responsibility for any infringement of their terms – details of these licences and acts are available from library staff.

8.3 The Student will not adapt the recording in any way.

8.4 The Student will not copy or alter recordings from the DVD or CD.

8.5 Any recordings borrowed will be used for educational purposes only.

8.6 The Student will not allow any use by any person other than accredited staff or students of Eve Therapy Training & Counselling Services Ltd.

8.7 The Student agrees to fund or replace any recording should it be damaged, lost, stolen whilst on loan to them.

9.0 Liability

9.1 The Centre accepts no responsibility for any loss or damage to the property (including any motor vehicle or cycle) of the Student whilst on Centre premises, nor for any personal injury suffered by the Student, unless, in the latter case, caused by the Centre’s negligence.

9.2 The Centre hereby expressly excludes liability for any direct or consequential loss which may be suffered by the Student as a result of any breach by the Centre of these conditions or any other act or omission of the Centre or its employees or agents.

9.3 In the event that the Centre is found liable to the Student for any breach by the Centre of these Conditions or for any other act or omission of the Centre or its employees or agents, the liability of the Centre shall be limited to the Fees actually paid (except of liability for death or personal injury resulting from the Centre’s negligence).

10.0 Circumstances Beyond the Centre’s Control

10.1 The Centre shall have the right, without liability and without being deemed to be in breach of these Conditions, to cancel the whole or any part of the Course which it has agreed to provide under these Conditions where it is prevented from providing the same through any circumstances beyond its control.

10.2 For the purposes of Clause 11.1, circumstances beyond the control of the Centre shall include (but shall not be limited to) strikes, labour disputes, student sit-ins, civil disturbances, floods, fire, death or absence through illness or injury of staff, unforeseen absence of staff, damage to buildings and the enforced closure of buildings.

10.3 Where any classes are cancelled as a result of circumstances covered by this Clause 11, the Centre may attempt to rearrange such classes but shall be under no obligation to do so.

11.0 Entire Agreement

12.1 These Conditions represent the entire agreement between the Centre and the Student and supersede and replace all prior communications, representations, warranties, stipulations, undertakings and agreements whether oral or written between the parties.

12.0 Headings

12.1 The headings of the Clauses of these Conditions shall not affect the construction of these Conditions.

I confirm that I have read and agree with Eve Therapy Training & Counselling Service's Student Terms and Condition. I understand that failure to comply with these conditions, may mean that I could be suspended from my course of study and/or be asked to leave the course. I understand that I will not be elgible for a refund and that I will still may be expected to pay any outstanding course fees owed.
Print Name: *

First Name Last Name
Sign: *

Clear
Date Completed: *

Month Day Year
Date
Please upload a photographic image of one of the following ID's: - Driving License - Passport - National ID *

Cancel of
Please upload a photographic image of one of the following acceptable documents as proof of residence: - Recent Utility Bill - Recent Council Tax Bill - A Full or Provisional Driving License - HRMC Revenue & Customs Tax Notification *

Cancel of
Level 4 Course Application Deposit

As part of your application, you will be required to pay the £200 deposit fee using the card payment option below. Should you be successful in being offered a place, you will be required to pay the remaining £400 to secure your place on the course.

If for any reason you are unable to pay by card, please email us (accounts@evetherapy).

Level 4 Application Deposit Payment:

Level 4 Application Level 4 Application deposit

£ 200.00

Total

£ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Disclaimer

I understand that the information given on this form can be used for any matter related to my application for a programme of study for the coming or future academic years, and for marketing and research purposes either by EVE Therapy Training & Counselling Services Ltd or by organisations employed by the organisation to undertake such work. I give my consent to the processing of data on this form on the understanding that the information I have supplied will be used only for the purposes set out above, and my consent is conditional upon the EVE Therapy Training complying with its obligations and duties in accordance with the the Data Protection Act 1998.
Should be Empty:

CPCAB LEVEL 4 IN THERAPEUTIC COUNSELLING (Year 1 & 2)

1. Important Information

2. Course Details

3. Personal Details

4. Emergency Contact (Next of Kin)

5. Residency and Nationality

6. Education

7. Counselling Qualifications and/or Experience

8. Learning & Support Needs

9. Employment Status

10. Household Information

11. Health & Well-Being

12. Criminal Conviction(s)

13. Personal Statement

14. References

15. Consent

16. Student Declaration

17. Student Terms & Conditions