Counselling application form

Thanks so much for your interest in working with Zephyr’s. In order to progress your application please fill out the below application form, once we have received this we will be back in touch to discuss the next steps.

Name

First

Last

Home address

Mobile number

Gender

Ethnicity

Tell us about your Counselling experience

For qualified Counsellors – What Counselling qualifications do you hold

You can skip the next question if you are studying towards a qualification

For qualified Counsellors – Your membership number (ie with BACP, UKCP or other)

Please state which professional body the number relates to

supervisor's Counsellors your

For student Counsellors – Your college/learning provider

(Name and address of Awarding Body)

For student Counsellors – Your tutors name and email address

For student Counsellors – Course title and year of study

For student Counsellors – What accreditation or level are you working towards?

(i.e BACP, UKCP)

For student Counsellors – How many placement hours are you looking for?

(i.e BACP, UKCP)

Insurer's name/company

Date of issue of insurance

Insurance reference number

What is your supervisor's name and email address?

When did you start supervision?

Please note – all counsellors and student placement counsellors will be expected to have your own supervision prior to working with Zephyr’s, and in accordance with your awarding bodies, or courses. Peer supervision will be offered, supported by Zephyr’s.

What CPD courses or learning opportunities have you engaged in?

Date/Year, Awarding Body ,Qualification Level / Title

Please tell us what motivates you to want to work with Zephyr’s, to support those bereaved following pregnancy loss or the death of a baby or child?

Please give details of two people who would be willing to provide a reference

Please include name, address, postcode, telephone, email address