Volunteer Counsellor Application.

All information is treated in the strictest confidence and used for administrative and monitoring purposes only.  

Name *
Gender *
Date of Birth *
Date of Birth
Home Address
Home Address
Name and Address of current training institute Professional Orientation Year of Training Areas of interest or additional training Current number of clinical hours (if applicable)
Name of University/College attended Degree(s) Obtained Years of Attendance
Qualification Obtained Years of Attendance
Name and Address of organisation Nature of Work Dates to and from
Tell us about about yourself, your skills and experience, and what you hope to gain from your experience as a counsellor at Headstrong Counselling.
Headstrong operates Monday to Thursday 9am-9pm and Saturdays 10-1pm. Please let us know which days/times would be suitable for you.
Preferred Placement Location *
Start Date *
Start Date
When would you be able to start?
Do you currently have a DBS certificate, if please provide your certificate number:
Please provide details of two referees. One reference from your training institution and ideally one reference from a previous employer/ Line Manager. If you are unable to provide either of those references, please let us know.