Earth Wisdom Therapy

info@earthwisdomtherapy.co.uk

Earth Wisdom Ecotherapy Community Interest Company

Qualified Counsellor Application Form

Thank you for your interest in joining Earth Wisdom Ecotherapy CIC. As a Community Interest Company, we are committed to providing accessible, inclusive, nature-based therapy. In addition to client work, all team members contribute to the running of the CIC to support its sustainability.

Please complete this form to help us understand your experience, interests, and how you’d like to be involved.

The role of Qualified Counsellor is a regulated activity and subject to an Enhanced Disclosure and Barring Service check. The cost of the enhanced DBS check is to be borne by the applicant.

First name

Last name

Phone

Multi-line address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Do you identify as having any disabilities, long-term health conditions, access needs, or allergies that you would like us to be aware of in relation to this role? This information is optional and shared to help us offer appropriate support.

Emergency Contact Name

Emergency Contact Phone

Relationship to you:

Qualifications & Experience

Counselling Training

Counselling CPD Qualifications

Counselling Experience

Total Number of Supervised Clinical Hours to Date

Personal History

Do you currently have a supervisor?

Do you currently have professional indemnity insurance?

Yes

Which recognised professional body are you registered with?

BACP

NCPS

UKCP

Do you currently have an Enhanced DBS Certificate?

Yes

Upon joining the CIC, I acknowledge my responsibility to obtain and maintain an up-to-date Enhanced DBS check and hold professional insurance, including the obligation to renew and update these documents as required.

Please share your availability below:

Times (broadly speaking)

9am - 3pm

4pm - 9pm

Other

* How many client hours per week could you take on?

* Are you comfortable offering a mix of indoor and outdoor therapy?

Funded clients are offered a series of 12 therapy sessions. While some of these may take place outdoors, some will be indoors, particularly for clients who are new to ecotherapy and may need time to adjust to the experience.

* Do you have specific client groups you specialise in or prefer to work with?

Employment History

For each role, please include where possible: organisation name, role/title, dates involved, and a brief description of your responsibilities (up to 500 words in total). If there are gaps in your experience, you are welcome to share a brief explanation

CIC Contribution

As well as being ecotherapy practitioners delivering sessions, workshops, and group activities, all CIC team members contribute to its operation across various areas, including:

Community Outreach Team – Manages social media, networking, and community engagement to raise awareness, promote our work, and build strong connections within the community. This team plays a vital role in creating visibility and fostering relationships that help us reach those in need of our services.

Funding & Grants Team – Identifies funding opportunities, writes grant applications, and manages donor relationships, ensuring the CIC’s financial sustainability. This team is essential in securing resources that allow us to expand our reach and continue delivering high-quality therapist paid services.

Additional Information

What draws you Earth Wisdom Ecotherapy CIC and our approach?

* Is there anything else you’d like to share about your skills, experience, or expectations?

Professional Reference

Please provide the contact details of at least one professional reference who can speak to your qualifications, experience, and character in relation to this role.

Signature

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Once we have reviewed your application, we will contact you to arrange an opportunity to meet and discuss how we can work together. Please let us know when you are free to attend.

Declaration

All information in this application is true and correct to the best of my knowledge and belief.

I understand that Earth Wisdom Ecotherapy CIC works within an ethical, trauma-informed and neurodiversity-affirming framework, and I am willing to reflect on my practice within this.

I consent to EWECIC undertaking all necessary checks, including verification of qualifications, professional membership, references and a satisfactory DBS/criminal record check.

I confirm that I have the right to work/volunteer in the UK and will be able to provide proof of status at commencement of this role.

Thank you for your time and interest!