Placement Applications Name * Name First First Last Last Gender * Date of Birth * Racial Identity * College / University / Training Provider * Phone * Email * Home Address * Course Name * Current Year / Level * Number of Face-to Face / Online / Telephone Client Hours * Student Membership BACP (or equivalent) * Are you in Personal Therapy, or have you been in Personal Therapy in the past? * Areas of Clinical Interest * Therapeutic Modality * Other Education * Relevant Work Experience * How do you define a successful therapeutic outcome, according to the modality in which you practice? * Do you address racial differences and sameness in the therapy room? If so, how, and why? * 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 Pathway Counselling. * Please tell us more about your choice to apply to Pathway Counselling 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? * If you have any issues with reading and/or processing that we/your interviewer should be aware of, please indicate here. * Are you currently a client at Pathway Counselling or have you previously been a client at Pathway Counselling? * Yes No Submit If you are human, leave this field blank.
