Counselling Courses – Application form | Highlands College Jersey

You are applying for the following course

The course you are applying for is *

Course descriptions are available on the website

Title *

Please select your preferred title from the drop-down list

Gender

Date of birth *//

Name *

First

Last

Please enter your first name and your last name(s) in the boxes exactly as they are stated on official documents, such as your passport, birth certificate or driving licence. If your name is too long for the available space please enter it in full at the beginning of your personal statement.

Preferred first name

Previous surname at 16th birthday

Address 1 *

Address 2 *

Post code *

Parish *

Home telephone number

Please enter your main contact number

Mobile number *

Please enter your mobile number

Email address *

Email

Confirm Email

Local emergency contact *

Name

Local emergency contact number *

Emergency contact number

Nationality *

Your nationality should be stated in your passport

Criminal convictions *

If you have any criminal convictions please select Yes; otherwise select No. If you select Yes you will not be automatically excluded from the application process. Refer to the guidance notes for a full explanation.

Disability / special needs *

If you have a disability, special needs (including dyslexia or another specific learning difficulty) or a medical condition, please select the most appropriate option from the list.

Disability - additional information

If you feel you may have a disability, special needs or a medical condition that has not yet been medically diagnosed you should give further details of the circumstances in this free text box .

Is English your first language *

Please let us know your first language. *

What is your ethnic group *

Please select from the drop-down list the category which most closely describes your ethnic origin. If you do not wish to provide this information, please select prefer not to say.

White ethnicity sub categories

Asian ethnicity sub categories

Black ethnicity sub categories

Another ethnicity sub categories

Mixed / multiple ethnicity sub categories

Religion or belief *

If you do not wish to provide the information, please select prefer not to say.

Sexual orientation *

If you sexual orientation is not included in the list select Other.

Do you identify as transgender *

Personal statement *

Academic qualifications *

Relevant experience

Declaration *

Yes

I confirm that the information given on this application is true, complete and accurate. No information requested or other material has been omitted.
By submitting this form I agree to the following. I need a minimum attendance of 80% to gain the qualification. Should my attendance fall below 80%, I may not be able to complete the qualification. I am not experiencing any severe emotional difficulty that may affect my participation on this course. If I leave the course, I understand that no refund or transfer will be offered by the college.

Who will be paying for this course *

Self
Employer
3rd party

Employer / 3rd party details *

Company name

Employer / 3rd party address 1 *

Employer / 3rd party address 2 *

Contact number *

You employer or 3rd party will be contacted for payment prior to you being enrolled on the course.

Post code *

Parish *

How will the course be paid for *

Single payment
3 Instalments (or less)
Monthly payment scheme

Instalment plan agreement *

I Agree that I have read and understood the following

I wish to pay the fees by instalments and understand that all fees must be settled 4 weeks prior to the final session of the course. The total cost of the fees are still due to the college should I withdraw from the course.

I agree to pay an administration charge of £15 or 2% of the total course fee, whichever is higher. This will be added if paying by more than 3 instalments (maximum number of instalments is 10).

To the best of my knowledge I have no outstanding debts with Highlands College, or any of its entities. I accept that my instalment plan and place on the course may be withdrawn if this is found to be untrue.

Someone from the Finance team at Highlands will be in touch regarding payment for the course

Counselling Courses – Application form

Online Application Form

Guidance notes