London Co-Counselling Course: Autumn 2019

Please fill in this form as honestly as you can. All information will be kept confidential by the trainer Kathleen. And if there is anything you'd like to discuss more you can do so by phone or in person. Email: kathleenspostbox@gmail.com Tel: 07871955394

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* 1. Please write a little bit about yourself and your life at the moment. These prompts may help you. What is happening for you right now? What would you like to change?

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* 2. What would you like to get out of this CoCounselling training and do you have any concerns about participating in this course?

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* 3. This training is suitable for people who are willing to listen attentively to someone else, as well as willing to receive the attention of others to help with their own life. How do you feel about doing these two things: listening and being heard?

Confident

Nervous

Unsure

Comment - please add any detail if this is of a concern to you.

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* 4. Is there anything you'd like to share with us about your mental health history? For example, any diagnoses or prescriptions that it could be good for us to be aware of.

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* 5. What suggested contribution (based on a sliding income scale) do you feel you can make towards this course?

£120-(For those who are unemployed/student )

£180 (For those with annual income of around £10,000 )

£210 (For those with annual income of around £15,000 )

£240 (For those with annual income of around £20,000 )

£270 (For those with annual income of around £25,000 )

£330 (For those with annual income of around £30,000)

£360 (For those with annual income of around£35,000 )

Add £50 for every 5K increase annual income after this

Other

If other (please specify)

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* 6. How did you find out about this Co-Counselling course?

Invite to the Facebook event

Facebook message/post from a friend

Word of Mouth (offline)

The trainer (Kathleen Cassidy)

Co-Counselling UK Website

Someone who has done a co-counselling course

Other (please specify)

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* 7. Please fill in this information so we can contact you about the course.

Name

Address

Phone Number

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* 8. Do you have any specific learning needs/requirements?

Yes. If so, please specify.

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* 1. Please write a little bit about yourself and your life at the moment. These prompts may help you. What is happening for you right now? What would you like to change?

Question Title

* 2. What would you like to get out of this CoCounselling training and do you have any concerns about participating in this course?

Question Title

* 3. This training is suitable for people who are willing to listen attentively to someone else, as well as willing to receive the attention of others to help with their own life. How do you feel about doing these two things: listening and being heard?

Question Title

* 4. Is there anything you'd like to share with us about your mental health history? For example, any diagnoses or prescriptions that it could be good for us to be aware of.

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* 5. What suggested contribution (based on a sliding income scale) do you feel you can make towards this course?

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* 6. How did you find out about this Co-Counselling course?

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* 7. Please fill in this information so we can contact you about the course.

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* 8. Do you have any specific learning needs/requirements?

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* 9. Do you have any feedback about this form? Thanks for filling it in!