Name:

Address:

Ph:

Email:

NOTE: Please mark as many options as you want below

1. Which course(s) are you interested in:

• Psychotherapy Studies
• Psychotherapy Training Program

2. When do you want to begin training?

• 2005
• Other:

3. Have you completed any previous training? Eg:

• Relevant Post-Graduate Training
• Relevant Under-Graduate Training
• Counselling: Certificate Diploma/Graduate Diploma
• Body-oriented training
• Other:
• None

4. Have you any relevant work experience (paid or unpaid) in the fields of Counselling or Psychotherapy?