General informationFields with a * are required.Preferred training programme Preferred starting date Gewenste startdatum Tweede Spoor CoachJe 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. DD dash MM dash YYYY 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? Amstelveen Rotterdam Utrecht Online (Monday) Online (Saturday) Preferred payment method* Pay the full amount at once Pay the full amount in 3 instalments* Payment by UWV (Ziektewet, WIA or WW)** Payment by employer 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). * Payment in instalments is only possible up to 3 months before the start of the training programme. ** This option is only possible if an official application for taking part in this programme has been filed with the UWV, and the UWV has requested to receive a quotation from us.* Betaling in termijnen is uitsluitend mogelijk tot uiterlijk 3 maanden vóór aanvang van de opleiding. 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). ** Deze optie is uitsluitend mogelijk indien er al een officiële aanvraagprocedure loopt bij het UWV voor het volgen van deze opleiding.UWVPayment by UWV If the UWV pays for the training costs, it is important that you have received approval from the UWV to request a quote from us. Have you received permission from the UWV to request a quotation from us?* Yes No Which UWV (social benefit) scheme applies to you?* WW WIA Ziektewet Please continue to fill in this questionnaire. We will send you a quotation by e-mail after approval of the questionnaire, which you can forward to the UWV. Please complete the questionnaire below and contact us once you have received permission from the UWV to request a quotation from us. Employer's detailsPayment by employer If your employer will pay the invoice, we kindly ask you to fill in the details below. Company Name* Contact person Street and house number* Postal Code* City* Employer's reference / PO number Email address invoice Personal informationFirst name* Last name* Company Name Date of birth* Place of birth* Street and house number* Postal Code* City* Email address* Phone number* Motivation & Other information1. Please describe your current life situation.*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.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 factors we need to take into account, and that you would like to share with us, that can influence your participation in the training programme?*E.g. mental or physical problems, 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.Intakegesprek Het werken met verslavingsvraagstukken vereist van jou als coach bepaalde competenties, motivatie en levenshouding. Om vast te stellen of de opleiding geschikt is voor jou, voert de docent een intakegesprek (45 minuten) met alle aspirant-studenten. Na het invullen van de inschrijfformulieren zal de docent een afspraak met je maken voor een gesprek via videobellen. Op grond van deze informatie uit het inschrijfformulier zal tijdens het gesprek worden bekeken of aan de eis voldaan wordt, om goed te kunnen functioneren in de opleiding en tevens of je het aankan om in de toekomst qua persoonlijkheid, ontwikkeling, en intellect cliënten te begeleiden. Last but not leastHow do you know the ACC? Google Facebook LinkedIn Friends / family I have previously followed a training programme with the ACC Dag van Herstel Have you attended an open day or online information session of the Academy for Coaching and Counselling?* Yes No Privacy Statement* I consent to the processing of my data in accordance with the privacy statement * 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. Furthermore, by submitting this form, you declare that the provided information is correct and true, and to the best of your knowledge. This questionnaire will be used to assess whether you can be admitted to your preferred training programme. The questionnaire will only be used for this purpose and will only be viewed by the management of the Academy for Coaching and Counselling and the relevant teacher of the training programme you are enrolling for. Δ Post on X Share on Facebook Share on LinkedIn Share via Email