Therapist Application Form

Name :

Address :

Postcode :

Telephone :
(please note it is essential that we have a landline telephone number in addition to a mobile number)

Email address :

Date Of Birth :

Please note, if you are applying to become an approved therapist, our requirement is that you must have external clinical supervision in place. Applications from individuals unable to meet these requirements will not be processed.

Please ensure that you meet the eligibility criteria for the position that you are applying for before proceeding as Anxiety UK is unable to issue any refunds pertaining to the £25 therapist admin fee.

Please state all qualifications along the awarding body and date of the award. (If you are applying for a therapist position, please ensure that your qualifications/training meet all of our criteria - see above).

Please give an idea of which days you can work, and when you can start

Please include details of positions you have held whether paid or unpaid that are relevant to the post.

Please detail membership of any professional bodies relevant to the post.

Yes No

Because of the nature of the work ANXIETY UK does and the fact that our volunteers will be working with vulnerable people, you are required by the Rehabilitation of Offenders Act 1974 to declare all criminal convictions including those which are spent. Please detail therefore any such convictions in the space below. (Please note: if you are applying to become a therapist, self-help facilitator or community befriender, a disclosure will be required in the event of you being offered a position with ANXIETY UK. A conviction will not necessarily be a bar to obtaining a position with ANXIETY UK).

Enter 'none' if you have no convictions

Please provide the names, full postal addresses (including post codes) and other contact details of two people who are not related to you, who can comment on your suitability for this type of work. Where applicable, one of the referees should be a course tutor. Applications submitted without the full postal addresses of referees will not be processed.

Postcode :

Yes No

Postcode :

Yes No

If you are able to give a donation in addition to the £25 registration fee, this would be very much appreciated

Please confirm that you have read and agree to the terms and conditions