Application

All information is treated in the strictest confidence and used for administrative and monitoring purposes only. We may also use your email to get in touch regarding important Headstrong updates.
Location
Name
Gender
Date of Birth
Racial identity
Email
Home address
Phone number
College/University/Training Provider
Course Name
Current Year/Level
Number of Face-to Face/Online/Telephone Client Hours

Please specify form of communication and organisation where work was undertaken

Student Membership BACP (or equivalent)
Are you in Personal Therapy, or have you been in Personal Therapy in the past?

If yes, state frequency and since when. If no, please clarify reasons

Areas of Clinical Interest

Client group or presenting issues that are of particular interest.

Therapeutic Modality

If Integrative, please specify which modalities you are integrating into your practice.

Other Education
Relevant Work Experience

Paid or Voluntary

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 Headstrong.
Please tell us more about your choice to apply to Headstrong 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.
Headstrong offers remote placements carried out on video platform. We ask for a minimum of 12 months of placement. Please tick this box to accept and to confirm you are able to complete your placement remotely.
If you answered 'no' to the above, please add your comment here
Have you applied for a placement with Headstrong in the previous 6 months?
Are you currently a client at Headstrong or have you previously been a client at Headstrong?
We're building the Headstrong community and want you to be a part of it. We'd like to stay in touch with you to keep you up to date with what we're doing. Would you like to stay in contact with Headstrong?

Thank you!