To apply for the CICS Online Certificate in Psychosexual Therapy please complete the form below.

The form will expand as you add content. Please provide as much detail as possible. Incomplete forms will not be accepted.

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Personal Information



Professional Training

Please detail all relevant qualifications including: Date, Qualification, Grade and Accrediting Body.

Relevant Work Experience

Please detail all voluntary or paid work related to the field of counselling and psychotherapy, sex, sexual health and relationship support.

Include dates (from-to) and roles/responsibilities.


Personal Statement

Access Needs

Emergency Contact Details


By submitting this form, you confirm that the information on this form is correct, to the best of your knowledge and wish to submit your application.

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