Application Form (L5 Diploma in Working with Children and Young People)
Level 5 Diploma in Counselling Children and Young People (CYP-L5)

Welcome to Maple Leaf Counselling & Training Centre. Please complete the form to start your application process.

The last question on the form gives a link - please open this link in a new window and book an interview slot, please return to this form, enter the date you have booked and submit the form. 

We look forward to seeing you soon!
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Which course are you applying for? *
Name (First name, Family / Surname) *
Address (incl. Postcode) *
Date of Birth *
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Telephone Number *
Email Address *
Are you currently employed / unemployed at this time? *
Why would you like to take this course? *
Do you have any learning needs, disabilities or mental health diagnosis that the training center would need to know in order to facilitate your requirements?  *
Do you have any mental ill health issues that may present concerns for you on this type of course? (Please read the course description on the main page for further information). *
In response to the previous two questions are there are reasonable requirements you would like to share with us? 
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Do you have a counselling placement already lined up? (This is not a prerequisite for coming onto the course). *
How many clinical hours have you completed? 

Please break them down to during qualification (eg. L4) and post qualification. 
 *
When and where did you do your Level 4 qualification or the equivalent?  *
What additional CPD you have done supports your application? *
Referee (1) - Please supply the details of a professional referee who you consider knows you well enough to complete a reference for you.  

Please supply name, relationship and email address. 
 *
Referee (2) - Please supply the details of a personal referee who you consider knows you well enough to complete a reference for you, this maybe a friend of work colleague. (We do not recommend using a direct family member or next of kin e.g. Mother / Father / Sibling / Partner) 

Please supply name, relationship and email address.  
 *
How will you be paying for the course? *
How did you hear about the course? *
Please use the attached link to book a place in one of our group interviews. Please feel free to select from any of the Level 5 Interview dates available.

Eventbrite Link

Please confirm that you have booked a slot below and select the date of your interview: 
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