Australian Association of Buddhist Counsellors And Psychotherapists PO Box 2115 Bondi Junction NSW 1355 www.aabcap.org PTCcoordinator@aabcap.org ABN 67 962 463 348 BUDDHISM & PSYCHOTHERAPY PROFESSIONAL TRAINING COURSE 2019-2020 APPLICATION FORM Name:... Please attach a recent passport size photo D.O.B: Address:... Suburb:...State:...Postcode... Phone:........ Mobile:... Email:..... Website:... Please provided all requested information and documentation with your application. If there s not enough space here then provide extra pages as needed. 1. Professional Qualifications Please provide information here re qualifications, dates obtained, university or institute, etc., and also attach or provide photocopies of your qualification certificates.
2. Other Relevant Training Please list your trainings and include photocopies of certificates to substantiate a minimum of 200 hours attendance in basic counselling / psychotherapy training. This is an entry requirement by PACFA standards and has to be acquired before joining this Buddhism & Psychotherapy Professional Training. 3. Membership of Professional Associations Please provide a list of your member associations and one document of a relevant membership. Please also provide evidence of your current Professional Indemnity Insurance if you work privately. 4. Clinical Experience & Supervision Please indicate the type of clients, frequency and duration of therapy you offer. Please indicate your years of clinical experience and include documentation to substantiate at least 50 hours of supervision. This is the minimum supervision requirement of a basic counselling / psychotherapy course set by PACFA. This has to be acquired before joining this Buddhism & Psychotherapy Professional Training. C5 Course Application Form V2.1 Page 2 of 6
5. Personal Psychotherapy/Counselling Experience Modality, frequency and duration 6. Work History Please give an account of your places of work, dates, and whether full or part time. C5 Course Application Form V2.1 Page 3 of 6
7. Meditation Experience Please outline your meditation practice, including tradition, teachers and retreat experience. 8. Reasons for Undertaking Training Please give an account of why you wish to apply for this training and what you hope to gain from the course. C5 Course Application Form V2.1 Page 4 of 6
9. Physical and Psychological Health Are there any issues related to your physical and/or psychological health that may affect your capacity to function in the small and big groups in class and in meditation during the two years of training? 10. Further Information Any further information about yourself that you may consider relevant to this application. 11. Do you identify as Aboriginal or Torres Strait Islander? 12. Referees Please supply the details of two people who are prepared to act as personal referees and know something about your work and/or meditation experience. 1. Name:.. Position:.. Phone: Email:.. 2. Name:.. Position:.. Phone: Email:.. C5 Course Application Form V2.1 Page 5 of 6
BUDDHISM & PSYCHOTHERAPY PROFESSIONAL TRAINING COURSE 2019-2020 I wish to undertake the Buddhism & Psychotherapy Professional Training Course offered by the Australian Association of Buddhist Counsellors and Psychotherapists. I agree to abide by the recommendations of the Training Committee in regard to selection for training. Signed:... Date:... Please attach a recent passport size photograph Please enclose a non-refundable administration fee of $250.00 with this application Direct Deposit payment to the following account: Account name: AABCAP Training Committee BSB: 062 236 Account number: 102 65303 Receipt # of payment:... Date paid:. Amount paid:.... Reference:.... NB: Important Note! Please ensure that your direct deposit details clearly include your name as a reference so that we can easily match your payment details. Please scan and email your completed application form to: PTCcoordinator@aabcap.org Please note that AABCAP is unable to support international student visas. For all further enquiries please contact us at: PTCcoordinator@aabcap.org Or call Deborah Edwards - Course co-ordinator on 0402 623 375, or email Sabina Rabold - Director of Training: dot@aabcap.org C5 Course Application Form V2.1 Page 6 of 6