Advanced Traumatology - Crisis Counselling & Management Course Registration Form

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* 1. Name of Course

Advanced Traumatology - Crisis Counselling & Management

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* 2. Scheduled Start Date of Course (Month & Year)

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* 3. Contact Information

Name

Address

Address 2

Country

Email Address

Phone Number(s)

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* 4. Gender

Male

Female

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* 5. Age Range

Under 20 years

20-29 years

30-39 years

40-49 years

50-59 years

60-69 years

Over 70 years

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* 6. Field of Employment

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* 7. Church/Organisation

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* 8. Kindly indicate which admission requirements have been met (select at least one)

GCSE or CSEC Pass(es)

Training in Ministry, Counselling, Psychology or related field

Proficiency in Reading & Writing

Recommendation from Church/Pastor or Organisation

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* 9. How did you hear about this course?

Church/Pastor

Relative/Friend

Email Marketing

Nation Newspaper

Radio

Other (please specify)

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* 10. What do you expect to gain from this course?

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* 11. How do you plan to use the knowledge gained?

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* 12. Date of Application

Date / Time

Date

Your registration form will be processed and Grace & Truth Critical Incident Training & Consultancies will contact you with further information.