Foundational Cyberculture Series Application
THIS APPLICATION IS A PREVIEW TO HELP YOU DETERMINE YOUR QUALIFICATIONS FOR OUR
FOUNDATIONAL CYBERCULTURE SERIES PROGRAMME
ONCE PAYMENT HAS BEEN MADE YOU WILL BE DIRECTED TO THE OFFICIAL APPLICATION
Criteria for acceptance onto the course
The Online Therapy Institute and the Online Coach Institute’s Foundational Series Programmes are open to anyone with an interest in the topic, but we require some documentation so that we can accurately allocate a training coach to you and be able to advise you should you choose to go on to complete a Specialist Certificate.
If you are a mental health practitioner or a certified coach, please fill all sections. Attachments to the application may be emailed, post mailed or faxed. If applicable, we require you to:
- Provide proof of an advanced level post-graduate qualification for mental health practitioners (UK Diploma, Master’s Degree, Doctorate) and Coach Certification or Certification-eligible for Coaches.
- For mental health practitioners: be under the supervision of a qualified mental health professional OR able to work independently.
- Be a member of a recognised professional body with an ethics code (BACP, APA, ACA, AC, ICF etc) or equivalent.
- Professional Indemnity (if you do not have Professional Indemnity/ Liability Insurance, you may still proceed. We require proof of this only if you are interested in participating in our Supervision Forum).
- Provide one reference from a colleague, Supervisor, or someone familiar with your education and abilities.
- Write a detailed justification statement outlining your education, work situation, and reasons for applying for the course.
If sections do not apply to you, please state N/A. We may come back to you for clarification.
SECTION ONE: Personal Information
Name:
Full address, including your Zip/Postcode:
Preferred email address (this email address will be the one you use to access the course if accepted):
Telephone numbers (landline and cell/mobile):
Summary of Qualifications and Work History
Please provide a brief summary of your qualifications and relevant work history. This information helps us allocate a coach to you during your learning. It would be useful if you could indicate the country your highest qualification applies to (see examples):
EXAMPLE 1:
Certificate in Counselling Skills, Diploma in Counselling, Masters (MSc) Integrative Therapy (University of Greenwich UK). I have worked in independent private practice, as an NHS counsellor (voluntary), and for a charity for adult survivors of childhood sexual abuse and their families. I am currently in private practice (part-time) and as part of a counselling/therapy team for an EAP in London (part-time). I also took two OTI short modules (ethics and email).
EXAMPLE 2:
Bachelors Degree in Marketing (Uni of GA, USA). I worked in Human Resources as an assistant and am now heading up a project in the same company to provide peer support for our employees in remote offices in Japan.
EXAMPLE 3:
Certified Coach Program with ILCT after graduating with a BSc in Psychology and Diploma in Counselling Skills with Barnam University. After training with ILCT I went into private practice as a Life Coach and run a successful but small practice with a client list of around 50 past and present. I am a Coach Member of the Association for NLP and run courses on group coaching within that organisation regularly.
SECTION 2: Education and Qualifications
Resume/CV
Please attach your resume/CV to your email with this form. You can also cut and paste it at the end of this form if you prefer, or post it to the addresses below.
Provide proof of advanced level/post-graduate qualification or coach certification
Please attach a scan of your qualification to your email with this form. You can also cut and paste it at the end of this form if you prefer, or post/mail to OTI/OCI.
Name of your clinical supervisor
If you are not yet able to work independently and you require supervision (for instance, you are working toward a professional license in the U.S.) please list the name of your clinical supervisor:
Professional Organisation Member Information
Please provide the organisation(s) you are a member of, your membership number if applicable, and indicate (*) the organisation that has the code of ethics you adhere to. If you are not a member of a professional organisation, please state what code of ethics you follow (see examples):
EXAMPLE 1:
BACP* (530937), UKCP, ISMHO
I follow BACP code of ethics (past member) and OTI Ethical Framework for Use of Technology
EXAMPLE 2:
In the U.S. if you are not a member of a professional organization, list the state’s code of ethics or certification code of ethics you follow such as Commission on Rehabilitation Certification or National Board of Certified Counselors
I am a Certified Rehabilitation Counselor so I follow the CRCC Code of Ethics* and/or I am a Distance Credentialed Counselor so I follow the NBCC Code of Ethics.
EXAMPLE 3
AC*. I am a member of BACP/BACP Coaching Division and the Association for Coaching
Professional Indemnity
Please attach a scan of your qualification to your email with this form. You can also cut and paste it at the end of this form if you prefer, or post/mail to OTI/OCI
If you do not currently have professional Indemnity, please explain why:
SECTION THREE: Application Justification
Interest in pursuing the Certificate
Please tell us in around 500 words why you are pursuing the Cyberculture Series training:
Reference Provider
We will follow up, via email, the person you supply to vouch for your suitability to undertake this foundational course. Applications will NOT be approved without this information. Please supply the name and email address of one person familiar with your work or education:
Special Needs
The Online Therapy Institute specifically welcomes and supports trainees with differing needs. If you have any needs that you think we should know about, please provide us with details on the form. We will endeavour to meet any needs you have and take them into account while on the foundation course, and will discuss this further with you to ensure they are met:
Course Expectations
If you have specific expectations about this course that are not listed in the course description, please let us know. We want to be sure that your professional development goals are met.
Preferred start date
Please bear in mind it will take up to 10 days to process your application and more if we are waiting for posted documents or a response from the person supplying you with a reference:
Good luck with your application and we look forward to having you join us for your training J
The OTI/OCI Team
CONTACT INFORMATION
Telephone
USA/CANADA
877.773.5591
UK and EUROPE
+44 (0)1506 511539
Email Address:
info@onlinetherapyinstitute.com
Post Address:
USA/CANADA
Online Therapy Institute, PO Box 392, Highlands NJ 07732, USA
UK AND EUROPE
Online Therapy Institute, 9 Lion Well Wynd, Linlithgow, EH49 7EL
FAX USA/CANADA
877.773.5591
