Student Counsellor Placement

Please fill out this application form

Step 1

Please note that by completing, signing and submitting this application, personal data will be held about you in line with Willow Project’s Data Protection Policy and Privacy Notice, details of which can be obtained by request from the office

Step 2

Availability

Step 3

Criminal convictions

Step 4

About

Step 5

Finished

  • Step 1
  • Step 2
  • Step 3
  • Step 4
  • Step 5

About

Name

Address

Telephone Number

Date of Birth (DD/MM/YY)

Email

College/University

Current year of study

When are you looking to start your student placement?

Please provide two references below. A personal reference can be anyone in your personal network, apart from family members, who can speak to your best attributes. Please only provide ONE personal reference

Reference 1

Name

Address

Telephone Number

Email

Reference 2

Name

Address

Telephone Number

Email

Relevant experience, qualifications and/or training

Counselling Qualification currently being studied, Course Title and University

Date started

Date finished/expected to finish

Relevant Qualification and Title

Date started

Date finished/expected to finish

Please let us know of any other relevant qualifications you hold.

Please let us know if you carry out CPD, and if you keep a CPD log

Do you have your Fitness to Practice?

Availability

Monday (double tap when using a mobile device)

Tuesday (double tap when using a mobile device)

Wednesday (double tap when using a mobile device)

We need to ask you about any unspent convictions as part of our duty of care. A criminal conviction will not necessarily prevent you from becoming a volunteer; the decision will depend on the type of offence and its relevance to the volunteering role. Most roles will also require a criminal record check.

Do you have any unspent criminal convictions? (double tap when using a mobile device)

You will be required to have a Disclosure and Barring Service (DBS) check if successful in your application. Please let us know if you currently hold an up-to-date DBS certificate.

About you

Please tell us a little bit about yourself and why you are interested in doing your placement with Willow Project.

Health

Any relevant health needs (physical or mental/emotional) that we need to be aware of in order to best support you

If yes, please specify

Let us know

How did you hear about Willow?

Signature

Please print your name here

Font Resize
Contrast