Psychology for Change Application Form

We collect information on applicants to Psychology for Change to help us build a better picture of the kinds of people who come onto our course. We use the application to try to get a sense that you’re at a time in your life when you could get as much out of the course as possible.

Please take the time to fill out the application form, providing us with as much detail as possible. We will bring up any concerns we may have about your readiness or suitability for the course with you through a risk assessment.

All data we collect is stored securely and not shared with anyone outside of the Foundation for Change team.

Personal Details

Name (required)

Address (required)

Postcode (required)

Phone number (required)

Email (required)

How can we contact you?

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Date of birth (required)

Psychology for Change (PfC)

We teach psychology in a way that helps you make sense of your past experiences and why your life has turned out like it has. What you learn also helps with your life in the present – current relationships and family dynamics for example. As such, PfC can sometimes be challenging and emotionally demanding.

How do you feel about the challenge of PfC?

What personal qualities do you think you will be able to bring to PfC?

What support structures do you have in place to support you over the duration of the course? (e.g. family, friends, connections to services, access to therapy/counselling)

Course access and availability

Psychology for Change is a two day a week, 8 week course that requires you to commit for a minimum 85%. This means that out of the 16 days, there are 2.5 days which it is possible to miss in the case of an unexpected event or illness. We strongly suggest, however, that to get as much out of the course as possible, you aim to attend every day. Alongside the training days, there are four, one hour tutorials, once a fortnight.

Are able to commit to attending each day for the entire duration of the day over the eight-week course? Is there anything that might get in your way? Do you have any forthcoming commitments that will mean you miss days on the course?

Do you have access to a mobile phone, a personal computer or a tablet, Wi-Fi, and a quiet space you can use during the tutorial hours?

Do you have basic IT skills - enough to be able to regularly check your emails, click onto a link to a Zoom meeting, etc?

How confident are you to use Zoom? Please let us know if you’d like any additional support from us to help you use Zoom to access the course.

Do you have any learning support needs such as dyslexia, numeracy, literacy

Are you currently employed?

Do you care for any children? If yes, please list their ages

Are you a lone parent?

Your experiences of drugs/alcohol

What substances have you used problematically?

At what age did you start using drugs and/or alcohol problematically

How long did you have a problem with drugs/alcohol for

If you are currently abstinent, please state how long you have been abstinent for?

If you are on a substitute medication like Methadone, Subutex etc, please state what medication you are on and how many milligrams:

Your experiences of substance misuse treatment

How many times have you been in treatment

What is/was your experience of substance misuse treatment? Did it help you? Or perhaps not? Please give a bit of detail below.

What was the last treatment service you accessed? Examples might be a day programme, residential rehab, aftercare services, etc.

If you addressed your substance misuse yourself and without accessing treatment services, please provide some information about how you did so and when that was.

If you have a key worker/recovery worker or Care Coordinator for your mental health, please list their name, job role and contact details including email and phone number.

Mental health

Have you had any mental health issues in the last two years? For example – depression, anxiety, psychosis, suicidal thoughts. If yes:

What are/were the mental health issues?

What treatment have you or are you receiving for your mental health issues?

Are you taking prescription medication? If yes, please specify what type, amount and how long you have been on the medication.

Criminal background

Do you have a criminal record? If yes, please list your offences (type and year charged).

If you were sentenced to prison for any offences, please state how many times you were in prison.

Have you ever committed any violent crime? For example – assault, armed robbery, rape. If yes, please state the offence(s) and year in which you were charged.

How did you hear about Psychology for Change?

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