| Nationality: | Date of Birth: |
| EMPLOYMENT: Please list all employment in the past 7 years. Continue on a separate sheet if necessary |
| Dates | Post | Employer |
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| EDUCATION: Please list all education since age 18. Continue on a separate sheet if necessary |
| Dates | Course | Qualification
Obtained | Institution/Awarding Body |
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THERAPEUTIC TRAINING OR OTHER RELEVANT EXPERIENCE OF PSYCHOTHERAPY/COUNSELLING PRACTICE |
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RELEVANT EXPERIENCE OF BODY-RELATED THERAPIES, MOVEMENT, DANCE OR SIMILAR WORK |
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SPIRITUAL AFFILIATION OR INTEREST |
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OTHER RELEVANT EXPERIENCE: please any experiences not included above that support your application or that have contributed to your interest in this training programme. These may be in helping, in cultural or community activities, in the arts, in leisure, etc. |
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HOW WILL YOU FINANCE YOUR STUDIES? |
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WHAT IS YOUR CURRENT STATE OF HEALTH? |
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HAVE YOU EVER BEEN SUBJECT TO A DISCIPLINARY PROCEDURE OR CRIMINAL PROSECUTION OR BEEN EXPELLED FROM ANY PROFESSIONAL INSTITUTION? | YES/NO |
| If yes, please provide a full account of the nature, reasons and outcome on a separate sheet |
PLEASE SUPPLY NAMES, ADDRESSES, PHONE AND E-MAIL FOR TWO REFEREES
These should be two people who can comment on your ability to fulfil the course academically and in terms of inter-personal skills. |
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PERSONAL STATEMENT (in 200-300 words say why you want to join this programme) |
- I understand that course requirements may change from time to time
- I have considered the financial implications of joining the course
I wish to apply to join the training programme. I enclose £10 non-returnable administration fee. I am available for interview on the next advertised interview date (see web information).
Signed
Date
Please return this form to:
Amida Trust
The Buddhist House, 12 Coventry Road, Narborough, Leicestershire LE19 2GR
THANKYOU
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