London Co-Counselling Course: Application Form

Please fill in this form as honestly as you can. All information will be kept confidential by the trainers Kathleen and Owen. And if there is anything you'd like to discuss more you can do so with us by phone or in person. Contact kathleenspostbox@gmail.com for more info.

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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? What obstacles do you wish to overcome?

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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 only suitable for people who are able to put aside their own troubles and listen attentively to someone else, AND awarely use the attention of others to help in their own life? Do you feel you can do both these things?

Yes

If yes, can you briefly describe two recent examples of 1) when you listened carefully to someone who was having a difficult time? 2) were able to receive the attention of someone when you having a difficult time

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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?

£100-(For those who are unemployed )

£160 (For those with annual income of around £10,000 )

£190 (For those with annual income of around £15,000 )

£220 (For those with annual income of around £20,000 )

£250 (For those with annual income of around £25,000 )

£300 (For those with annual income of around £30,000)

£350 (For those with annual income of around£35,000 )

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)

One of the Trainers (Kathleen/Celia)

Co-Counselling UK Website

Other (please specify)

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* 7. What is your name?

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* 8. What is your phone number? We arrange phone calls with all applicants before the course. This is just a short call to answer any questions you may and find out a bit more about your interest in doing the course.

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* 9. What is your email address? We need this to send you information about the course. We will be in touch with within a week of you filling in this form, with more information.

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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? What obstacles do you wish to overcome?

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 only suitable for people who are able to put aside their own troubles and listen attentively to someone else, AND awarely use the attention of others to help in their own life? Do you feel you can do both these things?

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. What is your name?

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* 8. What is your phone number? We arrange phone calls with all applicants before the course. This is just a short call to answer any questions you may and find out a bit more about your interest in doing the course.

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* 9. What is your email address? We need this to send you information about the course. We will be in touch with within a week of you filling in this form, with more information.

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