Application Form

APPLICATION OPTIONS:

Please select your application choice below:

Certificate in Adoption Support Counselling

Content Warning

I have read and understood that some of the material contained in this course may be emotionally distressing.

PERSONAL DETAILS:

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Title

First Name(s)

Last Name

Address Line 1

Address Line 2

Town/City

County

Post Code

Daytime Telephone

Evening Telephone

Mobile Telephone

EDUCATION & QUALIFICATIONS:

Please provide a brief summary of your education and qualifications.

N.B. FOR THIS COURSE YOU MUST HAVE AT LEAST A LEVEL 4 OR 5 COUNSELLING / PSYCHOTHERAPY QUALIFICATION OR EQUIVALENT TO BE CONSIDERED.

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Education List

Start & End Dates (Month/Year)	Institution	Location	Subject	Qualification(s)

RELEVANT EMPLOYMENT (MOST RECENT FIRST):

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Employment History

Name & Address of Employer	Start & End Dates (Month/Year)	Occupation & Responsibilities

* EXPERIENCE:

Below, please give the fullest details available of your experience as a practising counsellor / psychotherapist. This should consist of at least 100 hours, including placement hours whilst a student (number of hours, dates, supervision arrangements, types of client worked with, employment / voluntary / agency / placement):

Experience

* REASONS FOR APPLICATION:

Please explain why you wish to undertake this course and what you hope to gain from it. This is an important section in helping us to assess your application.

Reasons for Application

THE ALBANY CENTRE requires this information for education purposes and equal opportunities monitoring, your personal data will be processed in accordance with the current Data Protection legislation. This information will not be disclosed to any unauthorised parties.

Ethnicity *

Ethnic Group

Ethnic Subgroup

Gender

Do you have any disabilities?

Yes

If "Yes", please indicate the nature of any disabilities (tick ALL appropriate options):

I have Dyslexia

I am Blind / Partially sighted

I am Deaf / Hard of hearing

I am a Wheelchair user / Have mobility difficulties

I need personal care support

I have mental health difficulties

I have an unseen difficulty (e.g. diabetes, epilepsy, asthma)

I have a disability not listed

Please specify any applicable disabilities not listed:

Please select your preferred session below:

Wed 4th March 2026 (7pm-9pm)

Tues 28th April 2026 (1pm-3:pm)

I unable to attend either session (you will therefore be invited to a future date)

ZOOM SESSION:

As part of the course, you are invited to attend one Zoom session which provides an opportunity to ask questions about being an adoption counsellor and to address any queries you may have arising from the course. It will be hosted by two adoption therapists.

DECLARATION:

Please complete the following declaration by ticking the box and completing the remaining information:

I declare the following:

This completed application and contents for the Certificate in Adoption Support Counselling course contains only true and accurate information.

Signature

Date

Please complete the application form below for the Certificate in Adoption Support Counselling Training.

Warning: you may find some of the material contained in this course emotionally distressing.