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Counsellor Application

Application Form

Become a Counsellor/Psychotherapist

If you would like to become a counsellor at Safehaven Counselling, please fill out the application below.

Placement Counsellor
Fully Qualified Counsellor

Name *

Date of Birth *

Location *

Ethnicity

Phone *

Email *

Gender *
MaleFemaleNon-BinaryOther

Home Address *

College/University/Training Provider *

Course Name *

Current Year/Level *

Number of Online Client Hours *

Please specify form of communication and organisation where work was undertaken

Student Membership BACP (or equivalent) *

Are you in Personal Therapy? *

If yes, state frequency and since when. If no, please clarify reasons

Areas of Clinical Interest

Client group or presenting issues that are of particular interest.

Therapeutic Modality

If Integrative, please specify which modalities you are integrating into your practice.

Other Education

Relevant Work Experience *

Paid or Voluntary

How do you define a successful therapeutic outcome, according to the modality in which you practice?

How do you think your personal life experiences inform (or will inform) your ability to sit in the room with someone who is distressed?

Please tell us more about your personal and professional qualities that would make you a good candidate for Safehaven.

Please tell us more about your choice to apply to Safehaven for a placement.

If there is anything else you would like us to know about you, please do so in the personal statement here:

When can you start seeing clients? *

Are you currently a client at Safehaven or have you previously been a client at Safehaven?
YesNo

Your information will never be shared or sell to anyone.
We respect your private information

Name *

Date of Birth *

Location *

Ethnicity

Phone *

Email *

Gender *
MaleFemaleNon-BinaryOther

Home Address *

Professional Membership *

Therapeutic Modality

If Integrative, please specify which modalities you are integrating into your practice.

Education/Qualification:

Client Group: *

Days available for clients: *

Your information will never be shared or sell to anyone.
We respect your private information

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