Application Form

APPLICATION FORM

* Indicates required field

Course Title: *

Course Commencement Date *

Full Name (as in NRIC/Passport) *

Address *

Nationality *

Email *

Contact Telephone (Office and/or Mobile) *

Date of Birth *

Marital Status *

NRIC/Passport No: *

Gender *

Male Female

Occupation & Company's Name *

Highest Academic Qualification *

Any Counseling Experience *

Yes No

Reasons for Applying for this course *

Are You Currently Undergoing Psychiatric Treatment *

Yes No

Other Course Currently Pursuing *

Religion (for food catering purpose) *

I agree to the withdrawal policy *

Yes

Name of Introducer *

Submit

Affiliated with

TO COMPLETE THIS FORM
All questions must be answered. Incomplete application forms will not be processed.

DEFERMENT
No deferment is allowed. You are advised to work out your schedule before commiting to signing up for this course.

SAFETY TO PRACTICE
Lee Community College has a duty to ensure its trainees will be safe, competent and ethical to undertake our training. If you are actively addicted to drugs or alcohol; have an unspent criminal conviction or any history of criminal violence or sexual offences - we may have to defer your application.

If you have a past history of addiction to drugs or alcohol; any history of depression; any criminal history; have been subject to any complaints procedures related to this field; have been diagnosed mentally ill; are recently seriously bereaved or are pregnant or epileptic - we may be able to accept your application but you must indicate this in the declaration on the Application Form and enclose a covering letter which fully discloses your situation.

Registration is only confirmed upon receipt of payment via Paypal.

PAYMENT via PAYPAL

CERTIFICATE COURSES

$785.00

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Counseling Psychology.
CBT, Marriage Family,
Educational Psychology, etc

CONTINUING EDUCATION (CE's)

$35.00

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Alumni of LEE

CONTINUING EDUCATION (CE'S)

$55.00

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PUBLIC

WITHDRAWAL POLICY
Written notice is required in writing to LCC via letter or email to [email protected]. If a notice of intention to cancel is received and acknowledged by LCC more than 14 days before course commencement date, 100% of the course fee minus S$45.00 administrative fee will be granted. No refund will be made for withdrawal notice given less than 14 days before course commencement date.