College Placement Application

Your name

Your email

Your phone number

Date of birth

College

Degree level
Level 7Level 8Level 9

Do you have previous counselling experience?
YesNo

If yes, please give a brief explanation

Do you have previous training?
YesNo

If yes, please give a brief explanation

Are you garda vetted?

Do you have Counsellor Insurance?
YesNo

Please tick areas which you are able to work in, during this placement.
One to One counsellingGroup CounsellingCouples CounsellingChildrens CounsellingAdolescents CounsellingAddictionMindfulnessPerson centredCBTOther

If other, please elaborate.

When are you looking to begin your placement?