In-person Certificate Training Application Form - School of Play and Creative Therapies

Certificate training application form (in person)

Thank you for taking the time to fill in this application form as accurately as possible.

You will not be able to save this form once you’ve started to fill it out. Prior to completing this application form, please ensure you have:

Your qualifications, dates completes and governing bodies.
Full working history (employer, dates to and from and role undertaken.)
DBS, ICO and Oublic Liability Insurance information.

Once we receive your application, please allow us up to 10 working days to review your form. If you are eligible for this course we will contact you with payment information. Many thanks, School of Play and Creative Therapies Team.

Full Name

Address

Telephone number

Course

Course Date

Course Location

Please list any relevant qualifications you have and the date they were awarded

2 years Clinical Experience: training and post qualifying hours, client group (ages), model of therapy trained. (maximum of 500 words)

Employment history including voluntary, self employed work, full working history is required, any gaps in employment must be explained.

Working with children and young people requires students to hold an Enhanced DBS, Police/Suitability Check, Access NI, Garda Vetting, Scottish PVG which is less than three years old

I can confirm that I hold an Enhanced DBS, Police/Suitability Check, Access NI, Garda Vetting, Scottish PVG which is less than three years old

Enhanced DBS, Police/Suitability Check, Access NI, Garda Vetting, Scottish PVG Reference number

Enhanced DBS, Police/Suitability Check, Access NI, Garda Vetting, Scottish PVG Date of Issue

ICO Registration number if applicable (UK Only)

Date issued

Name of Public and Professional Indemnity Insurance Company:

Policy number

Date issued

Clinical Experience: training and post qualifying hours, client group (ages), model of therapy trained. (maximum of 500 words)

Professional Membership organisation and membership number

Have you had any complaints made against you?

If 'yes', please provide details

Have you ever been refused membership?

If 'yes', please provide details

Do you require any reasonable adjustments or support to access this course?

If 'yes', please provide details

Please let us know if you have any dietary requirements, including food allergies.

Emergency contact name and details

Relationship to emergency contact

How did you hear about this School of Play and Creative Therapies course

If you selected 'other', please tell us more

Can you provide two referees and their contact details, one referee must be from your current place of work and current clinical supervisor. If you are in Private Practice the referee must have known you for at least three years.

Yes

Referee 1: Name

Referee 1: Email address

Referee 1: Telephone number

Referee 1: Relationship to applicant

Referee 2: Name

Referee 2: Email address

Referee 2: Telephone number

Referee 2: Relationship to applicant

Please confirm you have read our privacy notice https://schoolofpact.com/privacy-policy/

Yes

I declare that, to the best of my knowledge and belief, the information given on this application form and supplied with it, is correct.

Yes

That by submitting this form you also declare that, if you are successful in your application, you will notify the School of Play and Creative Arts should there be a significant change in your circumstances that relates to the screening process: for example, criminal offence charges and convictions, restraining orders, injunctions, intervention orders, disciplinary proceedings and investigations.

Yes

Do you consent to the School of Play and Creative Therapies storing your data?

Yes No

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