Swinburne University of Technology

in conjunction with the

Executive Counselling & Training Academy

Mount Elizabeth Hospital & Parkway College

APPLICATION FORM FOR ADMISSION
MASTER OF SOCIAL SCIENCE (PROFESSIONAL COUNSELLING)

* Required field

STAGE 1
Graduate Certificate of Social Science (Professional Counselling) - 28th Intake
Course Commences: 30 Sept 2017
Closing Date: 30 Aug 2017
STAGE 2
Graduate Diploma of Social Science (Professional Counselling) - 27th Intake
Course Commences: 21 Oct 2017
Closing Date: 21 Sept 2017
STAGE 3
Master of Social Science (Professional Counselling) - 26th Intake
Course Commences: 16 Dec 2017
Closing Date: 16 Nov 2017

1. PERSONAL DETAILS
Name (as in NRIC / Passport) *
NRIC / Passport Number *
Country of Birth *
Citizenship *
Date of Birth *
Marital Status *    
Religion *
Language(s) Spoken *
Phone Numbers
Mobile *
Home
Office
Fax
Email Address *
Address according to Identity Card (NRIC) *
Actual mailing address
if it differs from Identity Card address
2. EDUCATION DETAILS

Post-Secondary / Tertiary Studies *

List all tertiary or post-secondary courses attempted including any in current year.

Name of Institution Name of Qualification
(Degree or Diploma)
Years Attended Completed
Yes No
Yes No
Yes No
Yes No
Yes No

Please indicate whether your highest qualification was awarded by:

University Degree (Overseas - Studied on Campus)
Diploma (Overseas - Studied on Campus)
University Degree (Through Distance Learning)
Diploma (Through Distance Learning)
University Degree awarded by Local University
University Degree awarded by Local Private Education Institution
Diploma awarded by Local Polytechnic
Diploma awarded by Local Private Education Institution
Have you ever been precluded from further study at this University or any other higher education institution? * Yes No
If Yes, please give details:

3. ADDITIONAL INFORMATION
Other qualifications or certificate of attainment or competencies * Yes No
If Yes, please give details and the year you attained the qualification and certification
Are you sponsored by an organisation? * Yes No
If your response is "Yes", please provide name of organisation

4. EMPLOYMENT & WORK EXPERIENCE

Details of relevant employment or work experience (in chronological order)

Organisation Position or Title Dates Full
Time
Part
Time
From To
Present Occupation
Title
Since
Number of Years
Brief description of current roles, duties and responsibilities

5. ANTECEDENT
Have you ever suffered or are you suffering from any medical condition, illness, disease, mental illness or physical impairment? Yes No
Do you have any history of psychiatric disorder? Yes No
Are you currently taking any prescription drugs or medication? Yes No
Have you ever been convicted in a court of law in Singapore or in any country? Yes No
Have you ever been charged with any offence in a court of law in Singapore or in any country for which the outcome is pending? Yes No
If any of the answers is "YES", please furnish details:

6. DECLARATION
(a) I understand that all the information provided will be used in the admission process. The data will also become a part of my student record and may be used for all purposes relating to my studies in accordance with the procedures of the Swinburne University of Technology and the Executive Counselling & Training Academy.
(b) I declare that the information given to support this application form is accurate and complete. I am aware that Swinburne University of Technology reserves the right to cancel my application at any time if the information given in this application is found to be untrue. If accepted as a student, I will comply with all conditions, rules and regulations of the University and its representative.
(c) This form collects personal data relevant to the processing of course application and other related administrative matters, including correspondence with the applicant. Data collected will be treated as confidential and used by the academy only for official purposes. If accepted into the relevant course(s), the student may from time to time participate in events organised by the academy where his/her image may be captured in photographs or video-recordings. By submitting this form, the applicant consents to the use of the data for the purposes indicated, and to photographs or videos containing his/her image being used on the school’s website or publications for publicity purposes.

7. CHECKLIST

Applicant can either mail to ECTA the under-mentioned documents or bring along to the interview.

The applicant must submit 2 copies of the following documents:

  1. GCE "O" Level Certificate and any other degrees, diplomas, certificates and official transcripts
    (Please bring the original documents for the interview)
  2. Professional resume
  3. A letter stating your reasons for wanting to apply for the counselling course
  4. Identity Card (both sides)
  5. Recent passport-sized photographs
  6. A recommendation letter from character referee
  7. Passport
  8. A non-refundable Application fee of $160.50 (GST inclusive)
    (Crossed cheque should be made payable to ECTA)

The completed application package should be mailed to:

Clinical Director
Master of Social Science (Professional Counselling)
Executive Counselling and Training Academy Pte Ltd
210 Middle Road
#07-02 Singapore Pools Building
Singapore 188994

7. Verification Code *
Enter the verification code:




Executive Counselling & Training Academy
CPE Registration Number: 200209120M
(Period: 20 June 2014 to 19 June 2018)