Australian Institute of Professional Counsellors

w   w   w   .   a   i   p   c   .   n   e   t   .   a   u

Australia's Only National Counsellor Education Specialist

Enrolment Form - Step 1 of 2.

 

Contact Details:
Your name: *
Residential Address: *
 
State: *
Post/Zip Code: *
Country: *
Telephone Number (b/h): *
Telephone Number (a/h):
Mobile Telephone Number:
Email Address: *

 

Postal Address Details:

Please only fill this in if your postal address differs from your residential address.

Postal Address:
 
State:
Post/Zip Code:
Country:

 

Personal Information:
Date of Birth (DD/MM/YYYY): - - *
Sex: *
Field of Employment:
Highest level of education completed (i.e.: High School, Certificate, Diploma, Degree):
Qualifications and Interests:
Are you applying to Centrelink for Austudy, Abstudy, Youth Allowance or PES?

Yes - At what percentage of assistance? No

Do you require assistace with Language, Literacy or Numeracy? Yes No
If you have a disability or special need, will you require additional learning support? Yes No
Please indicate your reason(s) for enrolling in the course:
For self interest
To assist in my current occupation
To set up a counselling practice
To seek employment
Where did you hear about the Institute:

 

Select the courses you wish to enrol in:
Please enrol me in the Diploma of Counselling*
with Advanced Study Majors in...
ADVANCED STUDY MAJORS

With our one-for-one Advanced Study Major offer, for every Advanced Study Major you select you receive another for FREE. Select the Majors you want from the list below, including the FREE one/s.

Abuse Counselling
Relationship Counselling And Conflict Resolution
Grief And Loss Counselling
Workplace Counselling
Career Counselling
Child Development And Effective Parenting
Counselling Clients With Addictions
Family Therapy
* Take advantage of our one-for-one Advanced Study Major Offer! For every Advanced Study Major you choose, you can select one for FREE
 
I have read and I agree to the terms of the Student Agreement*
* indicates a required field

 

Copyright © 2012 Australian Institute of Professional Counsellors