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Birchall Student Placement Application Form

Here at Birchall we offer a small number of placement opportunities for student counsellors and therapists across Cumbria and Lancashire. We have two intakes each year.

We’re delighted that you are considering a student placement with us. Offering counselling at Birchall isn’t your usual run of the mill placement, we provide a supportive and collaborative placement where you are valued and helped to grow.

 Please read the application form carefully as you fill it out.  This is important as it provides the only information we use to assess your suitability for a student placement and our decision whether to progress your application will be based on this information.

Personal Information
Do you hold a current full driving licence?
Do you require a work permit to enable you to work in the UK?
Do you have access to a car for travel?
Membership of Professional Bodies (e.g. BAPT, BAAT, Health Care Professional Council) - if applicable
Current Education/Training
Existing Voluntary Placement

Please include any voluntary placements you are attending and how many hours completed so far.

Why Birchall?
Probity - Relationship to a Birchall Trust Charity Team Member (i.e. Employee, Trustee or Volunteer Member)

Please give details of any employee, volunteer, or trustee of the Board of The Birchall Trust to whom you are related.  Restrictions may apply to the appointment of persons, who are closely related to an existing Birchall Trust member whether paid or unpaid.  If you fail to disclose such information you may be disqualified from consideration or, if invited to be a volunteer, have this invitation withdrawn. 

Are you related to any person(s) employed by The Birchall Trust or those acting as a volunteer, or trustee?
Criminal Records, Disqualification & declaration

Important: Our work is with children and young people and we have a responsibility to make sure team members are not disqualified from taking a role working with children & young people. All our team members are checked with the Disclosure and Barring Service before they can join the team.  

Are you subject to any current outstanding disciplinary action or legal proceedings?
University Reference

Please ensure that you give one reference. Which should be your current education setting. 

Can we contact prior to starting the Placement?
Document Upload
Upload CV
Upload (Optional)

Data Protection

“I give permission for The Birchall Trust to process and hold on computer the information or data I have supplied or referred to including any information that I consider to be sensitive and personal.  I understand and agree that this information will also be held on my personal file, if I am engaged as a staff team member.”



“I agree that The Birchall Trust may ask my referees for comments on my suitability for the role and, where relevant, request details on my attendance, sickness levels, performance, conduct, reasons for leaving and suitability to work with children, young people and adults, where applicable.”


“I confirm that to the best of my knowledge the information I have provided on this form is correct and I accept that providing deliberately false information could result in my dismissal.”

Please leave up to 20 seconds for the form to submit. You will be redirected to the Equal Opportunities Form once it has been submitted. Thank you.

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