Liminal Space Training Application Form
Personal Information
Name
*
First Name
Last Name
Gender
*
Date of Birth
*
-
Month
-
Day
Year
Email
*
example@example.com
Contact Information
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
County
Postcode
Emergency Contact
Emegency Contact Name
*
First Name
Last Name
Relation
*
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Course Selection & Fees
Which course/event would you like to apply for?
*
Please Select
CPCAB Level 5 Diploma in Psychotherapeutic Counselling
CPCAB Level 5 Diploma in Trauma Informed Practice
CPCAB Level 2 Certificate in Counselling Skills
Please indicate how you would like to pay for this course:
*
Please Select
Full Course Fee Upfront
Deposit + Monthly Instalments
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Supporting Documentation
Please upload proof of membership to a counselling professional body (e.g., BACP, NCPS, UKCP, etc.)
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Please upload a copy of your certificate from your qualifying counselling course (e.g., Level 4 Diploma, Foundation Degree, or equivalent)
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If you cannot provide the documents above, please confirm:
I am a trainee therapist and expect to qualify before the post-qualifying course I am applying for.
I have misplaced/cannot find my qualification
I am in the process of renewing/changing my professional membership
Other
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Other Information
Is there anything else you would like us to know when processing your application?
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