Questionnaire for admission - The ACC

Questionnaire

This questionnaire will only be used to assess whether you can be admitted to the training programme. The data will be processed by ACC staff and will be shared with your teacher.

Fields with a * are required.

Preferred training programme

Preferred starting date

Gewenste startdatum Tweede Spoor Coach

Je kunt hieronder aangeven op welk moment je wilt starten met het supervisietraject Tweede Spoor Coach. De supervisor zal contact met je opnemen om concrete afspraken te maken over het traject.

Preferred location

Alternative option(s) training location*

The training programme will only be able to start with enough student registrations. In the unlikely event that your group will not be able to start, we will do our very best to offer you an alternative. Below, you can indicate whether you would also like to participate in another group. Click here to view the different locations and class schedules.

I am not able/willing to participate in another group

I can/want to participate in another group if necessary

At which other locations would you be able/willing to participate?

Amsterdam (vrijdag)

Rotterdam (zaterdag)

Utrecht (vrijdag)

Utrecht (zaterdag)

Online (Saturday)

I am willing to follow the training programme in Dutch

Alternative option(s) training location*

I am not able/willing to participate in another group

I can/want to participate in another group if necessary

At which other locations would you be able/willing to participate?

Amsterdam (Saturday)

Rotterdam (Saturday)

Utrecht (Friday)

Online (Wednesday)

Online (Saturday)

I am willing to follow the training programme in Dutch

Are you considering enrolling in a specialisation programme after this course?*

We are curious to know whether you're already thinking about continuing with a specialisation programme after Coaching and Counselling Year 1. Your response helps us better plan and tailor our support.

Coaching and Counselling English Year 2

Addiction and Recovery Coaching and Counselling

I'm not sure yet

I only want to follow Coaching and Counselling Year 1

The programme Addiction and Recovery Coaching and Counselling is a specialisation programme that is only available to those who hold a diploma in coaching/counselling. Please indicate below which situation applies to you.*

I am attending (or have completed) the training programme Coaching and Counselling Year 1 at the ACC

I have a diploma from the ACC, but I started the training programme before September 2019

I am enrolling with an approved exemption form

I have not yet obtained a diploma in coaching/counselling

I have obtained a diploma in coaching/counselling, but I have not yet received an exemption

Addiction and Recovery Coaching and Counselling is a specialisation programme that is only available to those who hold a diploma in coaching/counselling. If you do not yet hold a diploma in coaching/counselling, you will need to follow Coaching and Counselling Year 1 before being admitted to this training programme. Click here to register for our Year 1 programme.

Diplomas of other coaching/counselling institutes than the ACC have to be assessed before you can register. If you hold a coaching/counselling diploma from outside the ACC, please contact us to receive the exemption form.

Payment preference

Who will pay the tuition fees?*

I will pay for it myself

UWV (Ziektewet, WIA, WW) / city council

My employer / other party

How do you wish to pay for the training programme?*

Pay the full amount at once

Pay the full amount in 3 instalments*

* Payment in 3 instalments is only possible up to 3 months before the start of the programme.

Aanvullende betaalopties voor betaling in één keer (opleiding Verslaving en Recovery Counsellor)*

Ik wil jaar 1 en jaar 2 in één keer betalen en ontvang hiervoor één factuur.

Ik wil jaar 1 nu in één keer betalen en jaar 2 voor aanvang van het tweede jaar in één keer betalen (je ontvangt de factuur voor jaar 2 drie maanden voor de start van het tweede jaar).

NB: voor de opleiding Verslaving en Recovery Counsellor geldt dat er in 6 maandelijkse termijnen wordt gefactureerd (drie termijnen voor aanvang van jaar 1 en drie termijnen voor aanvang van jaar 2).

UWV or city council

Payment by UWV or city council
This option is only possible if there is already an official application procedure at the UWV or city council for following this training programme.

Have you received permission from UWV / city council to request a quotation from us?*

Yes

Which (social benefit) scheme applies to you?*

Please continue to fill in this questionnaire
We will assess whether you can be admitted to the training programme. You will receive a notification about this via email. The UWV or the city council will request a quotation from us, which we will share directly with them. Once the quotation has been approved, we will finalise your registration for the programme.

You can already start with completing the questionnaire below. We can then pre-assess whether you are eligible for joining the training programme. However, please be aware that we can only enroll you once the UWV or the city council has approved your participation. Therefore, please make sure to obtain approval from the UWV or the council as soon as possible.

Employer / other party

Please indicate below whether the employer / other party would like to receive a quotation first, or would like to be invoiced immediately.*

Employer / other party wants to receive a quotation first

Employer / other party wants to be invoiced straight away

Please fill in the details below to receive a quote.

Payment employer / other party
If your employer / another party pays the invoice, we kindly ask you to fill in the information below.

Company Name

Contact person

Street and house number*

Postal Code*

City*

Employer's reference / PO number

Email address for quotation*

Email address for invoice*

What (part of the) amount should be included on the quotation?*

The full amount

Part of the amount, being:

Amount to be included in the quotation:

Specify the amount that should be included in the quotation.

What (part of the) amount should be included on the invoice?*

The full amount

Part of the amount, being:

Amount to be stated on the invoice:

Specify the amount that should be included on the invoice.

Please continue with the questionnaire
We will assess a.s.a.p. whether you can be admitted to the programme. As soon as this is established with a positive result, we will issue the quotation as requested. You will be notified of the result by email. After the quotation has been approved by your employer / the other party, we will officially register you for the training programme. Please note: in the meantime we will not reserve a place in the training programme, so it is very important that the quotation process can be completed as soon as possible.

The remaining part will be invoiced to you. The information below under Personal information will be used for billing purposes.

Personal information

First name*

Last name*

Company Name

Date of birth*

Place of birth*

Street and house number*

Postal Code*

City*

Email address*

Phone number*

Motivation & Other information

I am attending (or have completed) the training programme Coaching and Counselling Year 1 at the ACC.*

Yes

Yes, but I started the training programme before September 2019

No, I am enrolling with an approved exemption form

1. Please describe your current life situation.*

2. What education have you followed so far?*

What is your highest level of education?

2. What education have you followed so far?*

What is your highest level of education?

3. What training courses have you followed so far, if relevant for this programme? What was the duration of these courses and what was your experience?*

E.g. training in the field of personal development, therapy/coaching, spiritual development etc.

3. What training courses have you followed so far, if relevant for this programme? What was the duration of these courses and what was your experience?*

E.g. training in the field of personal development, therapy/coaching, spiritual development etc.

4. What are the important themes in your life so far? Have you recognized any recurring patterns and if so, how have you worked on/with them?*

To be able to be a good coach/counsellor it is important to know yourself and your patterns, and to have worked on them.

4. What are the important themes in your life so far? Have you recognized any recurring patterns and if so, how have you worked on/with them?*

To be able to be a good coach/counsellor it is important to know yourself and your patterns, and to have worked on them.

5. What is your motivation to enrol in this training programme?*

6. Are there any matters we should be aware of that might affect your participation in the training programme?*

E.g. mental or physical issues, addictions etc.*

6. Are there any matters we should be aware of that might affect your participation in the training programme?*

E.g. mental or physical issues, addictions etc.*

7. If you have suffered from addiction yourself: how long have you been clean for? What have you done to overcome your addiction and what are you currently doing to stay in recovery?*

For participants who have been addicted themselves and want to apply their personal experience in a professional setting, it is important that they are clean before they start with the programme. If this is the case, a conversation with the teacher might take place, to assess whether the applicant has sufficiently recovered to participate in the training programme.

Intake interview

Working with addiction-related issues requires certain competencies, motivation, and a particular mindset from you as a coach. To determine whether the programme is a good fit for you, all prospective students take part in a 45-minute intake interview with the teacher. Once you have completed the questionnaire, the teacher will contact you to schedule a (video) call. Based on the information provided in your registration, the interview will explore whether you meet the requirements to participate effectively in the programme, and whether you are personally, developmentally, and intellectually ready to support clients in the future.

1. What is your motivation for participating in the Coaching and Counselling Year 2 training programme?*

2. Are there any practical or emotional issues in your personal situation that might hinder participation in the training programme?*

E.g. available time and space, family issues, illness, pregnancy, etc.

3. Have you encountered themes in the Coaching and Counselling Year 1 training programme that you are still working on/processing (unfinished business)?*

Yes

4. What are these themes and how are you working on processing them (by yourself or with support)?*

5. How do you expect to deal with (processing) these themes throughout the next training programme?*

6. Could this process complicate participation in the training programme?*

* Note: You are not obliged to share any medical details with us. By submitting this form you state that you have no severe psychological problems, and/or are not receiving psychiatric treatment at this time, as we consider this to be grounds for exclusion from admission. The training programme is not meant as therapy, but to help you become a coach/counsellor. For this reason, we apply a strict assessment for admission to our training courses, as certain psychological problems may impede your own learning process (as well as that of your fellow students). If in doubt, we will always contact you first to discuss this further.

Last but not least

How do you know the ACC?

Google

Facebook

Friends / family

I have previously followed a training programme with the ACC

Dag van Herstel

Other

Have you attended an open day or online information session of the Academy for Coaching and Counselling?*

Yes

I hereby declare the following:*

I have filled in the information on this form correctly and to the best of my knowledge.*

I consent to the processing of my data according to the privacy statement.*

I understand that by submitting this questionnaire, as soon as the quotation has been approved, I will enter into a binding agreement with the Academy for Coaching and Counselling, which entails a payment obligation, and I have taken note of the applicable general terms and conditions.*

I hereby declare the following:*

I have filled in the information on this form correctly and to the best of my knowledge.*

I consent to the processing of my data according to the privacy statement.*

I understand that by submitting this questionnaire I will enter into a binding agreement with the Academy for Coaching and Counselling, which entails a payment obligation, and I have taken note of the applicable general terms and conditions.*

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Questionnaire

Payment preference

UWV or city council

Employer / other party

Personal information

Motivation & Other information

Intake interview

Last but not least

Discover our course offering for Fall 2025 – download the study guide

Discover our course offering for Fall 2025 – download the study guide

Discover our course offering for Fall 2025 – download the study guide

Discover our course offering for Fall 2025 – download the study guide