Application for ICAEW Counsellor

Application for
ICAEW Counsellor
An ICAEW Counsellor is appointed by the Qualified Person Responsible for Training to undertake a student’s six monthly review. The
Counsellor must be a member of a CCAB body or international equivalent.
Please complete and return this form to
Training Authorisation LPD ICAEW Metropolitan House 321 Avebury Boulevard Milton Keynes MK9 2FZ UK
T +44 (0)1908 248 038 E [email protected]
APPLICATION DETAILS
ICAEW training office number L00
or X00
CCAB membership
ICAEW
ACCA
CIMA
ICAS
CAI
other
CIPFA
Membership number
Preferred title
Mr Mrs Miss Dr Prof other
Name (title/forename/surname)
Title/position
Date of birth
Organisation
DDMM YYYY
Primary business address
Postcode/zipcodeCountry
Telephone
Email
All counsellor requests for access to restricted areas of the website must be authorised by the QPRT or equivalent.
QPRT
QPRT name
QPRT signature
Date
DDMM YY
Using your personal information. We will treat any personal information collected on this form in accordance with data protection legislation. We will use
your information for administration, communication and research. To do this we will share your information with our student and district societies and with
organisations that help us administer our training and exams.
We may transfer your information outside the European Economic Area (EEA) eg, to one of our offices. These countries may not have similar data protection
laws to the EEA. So, if we do transfer your information we will take the necessary steps to ensure that your privacy rights are still protected.
For more information about our data protection policy please go to icaew.com/dataprotection http://www.
© ICAEW 2014 LPDDIG13162 08/14