Online Co-Counselling Course: Winter 2021, Evenings

The aim of this form is to help you understand why you would like to do this course. Please fill in this form as honestly as you can. All information will be kept confidential by the trainer. If there is anything you'd like to discuss you can do so by tel: 00447871955394 or email: cocounselling.training@gmail.com

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* 1. Please write a little bit about yourself and your life at the moment. What would you like to get out of this co-counselling training and do you have any concerns about participating in this course?

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* 2. 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?

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* 3. Is there anything you'd like to share about your mental health history? For example, any diagnoses or prescriptions.

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

Co-Counselling UK Website http://www.co-counselling.org.uk/

The trainer (Kathleen Cassidy)

Word of Mouth (offline)

Facebook message/post from a friend

Invite to the Facebook event

Other (please specify)

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

£75-(For those who are unemployed)

£105 (For those with annual income of around £10,000 )

£145 (For those with annual income of around £15,000 )

£195 (For those with annual income of around £20,000 )

£245 (For those with annual income of around £25,000 )

£295 (For those with annual income of around £30,000)

Add £10 for every £1000 increase annual income after this

Other

If other (please specify)

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* 6. Please fill in this information so you can be contacted about the course.

Name

Address

Phone Number

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* 7. Please note it is advisable to have someone in your area to practice co-counselling with in person, as part of this training. Whilst you will practice co-counselling remotely with other course participants via telephone/video call, it would be ideal to have another person/people in your area to do sessions with in person as well. It does not matter if you know the other person/people in your area: you can practice co-counselling with people you know, as well as those you don’t. So do you know anyone in your area who has also applied to this training? Or do you think you could speak with people who may be interested in applying? It is not mandatory to have someone locally to practice with, but it would definitely enrich your training experience.

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

Yes. If so, please specify.

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* 9. This training will take place online using Zoom. Do you have access to a computer you can use for the course and how confident do you feel about using technology for online learning?

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* 1. Please write a little bit about yourself and your life at the moment. What would you like to get out of this co-counselling training and do you have any concerns about participating in this course?

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* 2. 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?

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* 3. Is there anything you'd like to share about your mental health history? For example, any diagnoses or prescriptions.

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

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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. Please fill in this information so you can be contacted about the course.

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

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* 9. This training will take place online using Zoom. Do you have access to a computer you can use for the course and how confident do you feel about using technology for online learning?

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* 10. Do you have any feedback about this form? Thanks for filling it in. You will be contacted within 1 week of your application.