Diploma in Therapeutic Groupwork

Groupwork Application Form - September 2010

Application Details will be treated as confidential

Name:
Address:
Date of Birth:
Occupation:
Telephone:	(H) (W) (M)
Email Address:

Selection criteria include consideration of:

Minimum academic criteria: Literacy to Leaving Certificate level (or equivalent)

(Please select appropriate option below)

Primary Degree (BA/BSc)

Masters

Therapeutic Training Courses

Most Recent
Institution Attended:
Title of Course:
Dates of Attendance:
Qualification Achieved:
Attachment:
(Please attach a copy of any qualifications and other certificates you deem relevant)

(Give full details, of all relevant professional / work experience obtained. Include duration and nature of work and level of responsibility). Please note: professional experience is not essential to participate on the course.

Details:
Professional Association Membership:
Professional Accreditation:

There will be a requirement to use computers on the course

(For example to submit typed assignments or research projects). Please answer the following questions, so that we can assess how much support may be needed:

Do you have access to a computer/laptop?		At home?		At work?
Do you have access to the internet?		At home?		At work?
How proficient are you in the use of computers / internet facilities?		Familiar		Slighter

Details:

The cost of the Programme is €2950 per year. A non-refundable deposit of €1000.00 will be requested within 14 days of successfully securing a place on the course. Full payment is required before course commencement.

I certify that the information given above is correct and I agree to pay the course fee of €2950 in full.