Apply for the CICS Diploma in Pluralistic Psychotherapy

To apply for the CICS Diploma in Pluralistic Psychotherapy please complete the form below.

Please complete this application form in full and in detail so that we can fairly assess your suitability for this course of study. If you have any questions, please contact us.

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Personal Information

First Names*Preferred Name*Surname/Family Name*Gender IdentityPronoun(s)Date of Birth (dd/mm/yyyy)*Country of Birth*Nationality*Mobile Phone Number*Email Address*Website

Social Media Links

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Address

Address Line 1*Address Line 2Town/City*Post/zip Code*Country*

Education

Please detail all relevant qualifications gained since the age of 18 including: Date, Qualification, Subject and Grade.

Education*

Relevant Work Experience

Please detail all work related to the field of counselling and psychotherapy, sex, sexual health and relationship support.

Include dates (from-to) and roles/responsibilities.

Work Experience*

Eligibility

Please detail how you meet the course entry requirements.* (Max 100 words)

Group Dynamics

How would you describe your experience of working in groups? What role do you tend to take? What, if anything, do you find difficult about learning groups? * (Max 200 words)

Personal Statement

Please state your reasons for wanting to undertake this specific course of study. * (Max 500 words)

Access Needs

Please let us know of any formal diagnoses you have that may affect your learning and any associated access needs.

Criminal Convictions

Do you have any criminal convictions?*

Emergency Contact Details

First Name(s)*Surname/Family Name*Address*Mobile Phone Number*Relationship to you*

Referees

Please include the details of two professional referees.Referee 1: Name*Referee 1: Job Title*Referee 1: Email Address*Referee 1: Phone Number*Referee 2: Name*Referee 2: Job Title*Referee 2: Email Address*Referee 2: Phone Number*How did you hear about CICS? Social media, Google, told by a colleague/friend etc.*

By submitting this form, you confirm that the information on this form is correct, to the best of your knowledge and wish to submit your application.

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