You can download the form from the documents section of our website or email us directly if you need further information.Study ApplicationStep 1 of 812%I would like to apply for (Check appropriate box)*Foundation Course - Year 1Intermediate Course - Year 2Masters Course - Year 3, 4PERSONAL INFORMATION (*) Denotes a required fieldName* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Last Date of birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Home address* Street Address Address Line 2 Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Home tel no*Mobile tel no.*Email* Current job titleWork address Street Address Address Line 2 Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Work tel noWork mobile noWork email FURTHER EDUCATION & PROFESSIONAL QUALIFICATIONS(*)Which qualifications leading to registration with one of the following professional bodies do you have?Please tick the relevant box and specify qualification, Date course and place of study. It is an Association of Family Therapy requirement for admission to Intermediate and Masters level training to have a professional level qualification and the ability to study at post-graduate level as evidenced by an undergraduate degree. Applicant who do not meet both these requirements may, in exceptional circumstances, apply via the APEL route and be assessed for entry. Please see our APEL Policy on the Website. There is an additional charge for this process. If you wish to be considered under this route, please contact the course immediately to discuss this option. Psychology – Clinical Psychology, Educational Psychology and Counselling Psychology qualifications leading to registration with the Health Professions Council (HPC) Social Work – The generic professional qualification leading to registration Psychiatry and other medical specialities – For qualifying level training Speciality Training or staff grade is required. Teaching – With registration with the GTC, where individuals have had substantial experience in which they have worked with pupils and families in a counselling capacity. Nursing – Mental health nursing and other nursing specialities which require counselling skills. Arts Therapists (Art, Dance and Movement and Music Therapists), qualified and registered with the HPC. Counselling/Psychotherapy – Three year minimum training, with full BACP accredited membership (MBACP Accred) or an equivalent Psychotherapy body and experience in the public or voluntary sector is considered essential to establish equivalence. Occupational Therapy – qualified and registered with Health Professions Council. Speech and Language Therapy – qualified and registered with the HPC. N/A Application without qualification to Foundation level.Please specify subjects, place of study, years of study and qualifications gainedPlease specify any additional/alternative education and qualifications including subjects, place of study, years of study and qualifications gained:WORK EXPERIENCERelevant work experience*Please give details of relevant work experience starting with the most recentPlease note that it is an essential requirement for Intermediate and Masters level to have a suitable work context in which you can gain experience in addition to that available on the course. If in any doubt, please contact the course to discuss this.Intermediate applicants ONLY:*Can you fulfil the requirement for 60 hours of systemic practice with families in your work context?YesNoPlease state how this will be met.How will you meet the requirements? For example through an additional placement that you have arrangedMasters applicants (years 3 and 4) ONLYCan you fulfil the requirement for 100 hours of systemic practice with families in your work context?YesNoPlease state how this will be met.How will you meet the requirements? For example through an additional placement that you have arrangedApplicants for Foundation and Intermediate: Please complete the reference request form and send it along with the course outline to a professional referee who can comment on your work with families/children.Applicants for Intermediate and Masters ONLY: Please give contact details of your tutor from your previous training. If you have completed the FTTN Foundation/Intermediate training, please note the name of your tutor and the date you completed (or will complete) the course. If you completed your training elsewhere, please give full contact details and dates you completed (or will complete) the course.Name of tutorName of organisationDate of completion Date Format: DD slash MM slash YYYY Address Street Address Address Line 2 Postal Code Phone numberEmail SUPPORTING STATEMENTPlease describe your current employment, commenting on management support, and supervision available and how this training may benefit you and your agency? (word guide 500-1000 max)FOR OUR INFORMATION Please mark as many as apply to you:How did you hear about the FTTN? Facebook Twitter via AFT website Advert FTTN website Word of mouthWhere and when did you see the advert?Your Full Name*Your Date of Birth* Date Format: DD slash MM slash YYYY EQUAL OPPORTUNITIES MONITORING FORM As a training provider, we have a duty to collect relevant information relating to registrants to support the Equal Opportunities Policy. We are to maintain such records as are necessary for us to evaluate the efficacy of our policy and adapt it as necessary. Please do not put any identifying information or details on your form other than those requested. We understand that some of the information you provide may allow for the identification of some individuals, however this information will only be used for monitoring and evaluation purposes and will be kept confidential.Gender*MaleFemaleAge group*21 to 3031 to 4041 to 5051 to 6061 to 70Do you have children?*YesNoGender preference*I would describe myself as:HeterosexualTransgenderBisexualLesbianGay / HomosexualETHNIC ORIGIN How would you describe your ethnic origin? (please tick one)ASIAN OR ASIAN BRITISHAfghaniIndianBangladeshiPakistaniSinhaleseSri Lankan TamilAny other Asian BackgroundBLACK OR BLACK BRITISHCaribbeanGhanaianEthiopianSomaliNigerianAny Other African BackgroundAny Other Black BackgroundWHITEBritishScottishIrishRomaTraveller Irish / English / ScottishEnglishGermanPolishAlbanianKosovanEuropeanAny Other White BackgroundDUAL HERITAGE Please write which:OTHER ETHNIC GROUPSArabChineseIranianIraqiKurdishLebaneseAny Other Ethnic GroupETHNIC GROUPPlease use your own words to describe how you would identify yourself in terms of ethnic, national and religious origin. Feel free to add additional definitions of yourself as you see fit.PEOPLE WITH DISABILITIES The Disability Discrimination Act 1995 defines a person as disabled if they have "a physical or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities."Do you consider yourself to have a disability?*YesNoPlease specify the nature of your disability.Some examples of impairments that meet the definition of disability under the Disability Discrimination Act 1995 are; hard of hearing, partially sighted, severe back problems, arthritis, phobias, depression, speech impairment, dyslexia, diabetes, epilepsy, asthma and cardiovascular conditions.)MONITORING INVOLVES THE COLLECTION AND ANALYSIS OF INFORMATION ON:Registrants ethnic origin, gender, disability;The success rate of applicants for trainings according to their ethnicity, sex, and disability;Recruitment, training and promotion decisionsReports of breaches of the equal opportunity policy;Other information relevant to the application of the policy. THE INFORMATION COLLECTED MAY BE USED FOR THE FOLLOWING REASONS:To identify to what extent the current registrants reflect the population;To identify the source of applicants for trainingTo identify areas of significant, unexpected over and under representation;To analyse changes over time;To highlight trends in the organisation with an equal opportunity implication. This form is adapted from the Equal Opportunities form issued to training organisations by the UKCP. If you are accepted on the course, you will sent a payment form and asked to indicate how your fees will be paid. I AgreeCommentsThis field is for validation purposes and should be left unchanged.