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Interviews are conducted in a friendly and informal atmosphere. Due to the popularity of our courses, most interview days are over-subscribed. Please, therefore, only use this form if you’re seriously interested. If you just have general questions, please either call first or refer to our website. If invited for interview, we’ll contact you and you must confirm you can attend.

Applicants on benefits will only be granted an interview if they can secure funding in advance. If you can fund the course anyway, please indicate how, or, on receipt of this form, we will send you a Funding Letter.

Chrysalis® Course Application Form

Please complete all sections of this application form. If you have any questions regarding the form, please email or call 0844 411 9365

Are you on Income Support / Incapacity Benefit / Jobseekers Allowance? *

Qualifications and experience

Life Experience


I Confirm that I have read Safety to Practice and either:

Chrysalis has a duty to ensure its students 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 cannot accept 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; are recently seriously bereaved; have been diagnosed mentally ill; 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. (Pregnant and epileptic applicants may need medical permission due to the teaching of relaxation techniques).

Part 4 of the Disability Discrimination Act gives Chrysalis the right to exclude certain categories of applicant in the interests of public safety.

This form is signed with no obligation on either side to proceed with training

I certify that the information given by me on this form is true and that I have read and accept the Terms & Conditions