Course Application Form

You can print this form and send it completed by post or complete it on-line here.

As places on the course are limited, early application is advised.

Course Title: ………………………………………….

Course Date: …………………………………………..

PERSONAL DETAILS

Full name: …………………………………………….. Male/female

Age: [below 25]  [26-35]  [36-45]  [46-55]  [above 55]

Ethnicity: ………………………..Occupation: ……………………………………..

Address: ………………………………………………………………………………

Telephone no: (Landline)……………………………………

Mobile no:…………………….. Email: …………………………
Address for correspondence (if different from above):

………………………………………………………………………..

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OTHER DETAILS
Do you consider yourself to have a disability/special need? YES / NO
If so, please state your disability or describe any special need/support required to assist you with your training.

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Who will be responsible for paying your fees?

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What are you hoping to achieve by the end of the course?

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Where did you hear about this course?

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Method of Payment:
By cheque, postal order or PayPal payable to:
Change Birmingham Brief Therapy

  • Foundation in Solution Focused Practice £150
  • Certificate in Solution Focused Practice £150 + £50 marking fee = £ 200 per unit.
  • Diploma in Solution Focused Practice £150 + £50 marking fee = £200 per unit.
    CPD of 2 hours session £25

Terms and conditions:

  1. Acceptance for a place will be based on the requirement of meeting Change’s selection criteria.
  2. Your place on a course is not transferable.
  3. Payment should be paid in full upon the confirmation of a place and before attending the course, and it is not transferable.
  4. A £30 administration fee will be deducted from the refund of the payment should you decide to withdraw from the course.
  5. Should you defer payment to a later training schedule or a different course, an administration fee might occur.

I agree with the above terms:

Sign:…………………………………… Date:………………………………..

Reg. charity no: 1037463