Aphrodite School of Counselling & Psychotherapy: Level 2 Application

Aphrodite School of Counselling & Psychotherapy

Level 2 Counselling Skills Course, CPCAB
Student Name

First NameLast Name
Date of Birth

DayMonthYear
Date
Age
Place of Birth
Gender

Other
Phone Number

Country CodeArea CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityCounty

Post CodeCountry
Highest Grade Level Completed
School Year
School Last Attended
Relevant Professional Experience
References: at least one professional reference
Personal Statement: please share why you are applying, your relevant experience, and why you think you would be a good fit for this course. 500 words MAX.
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person

First NameLast Name
Emergency Phone Number

Country CodeArea CodePhone Number
File Upload

Photo ID
Upload
Health History
If the student has any allergies, please list them down below:
Does the student currently take any medications? If yes, please list them down below:
Does the student have any medical conditions that you would like to declare?
INTERVIEW. The school admin will conduct an interview with the student as part of the screening test.
Date Signed

MonthDayYear
Date
Applicant Signature
Should be Empty:

Aphrodite School of Counselling & Psychotherapy