Volunteer Counsellor Application Form

Date
Name
Address
Home Telephone
Mobile Telephone
Email
Have you applied before
If yes, when?
How did you hear of the centre
Do you work with
- Individuals
- Couples
- Groups
- Family
(Please tick all that apply)
Areas of special interest or expertise
Levels of Experience
Are you a student
Name of Training Centre
Number of client hours completed to date
Are you qualified but not accreditied
When did you qualify
Where did you qualify
Are you seeking Accreditation
With which body(s) are you seeking accreditation
Number of client hours completed since qualifing
Are you accredited
When was accreditation achieved
With which accreditation body
Where did you train
How many hours per week are you prepared to offer
Please list the times and days you would be available
Name of your liability insurance provider
Insurance renewal date
Level of insurance cover
Name of your clinical supervisor
How many hours personal therapy have you undertaken
Are you currently in personal therapy
Please describe your "model" or way of working with clients
Why do you want to volunteer with the Oasis Centre
Any other information you deem pertininant
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Phone
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Levels of Experience