Registration for the Alumni in Action Programme Survey

Alumni in Action: Pre Registration

Thank you for your interest in providing counselling services to survivors of SGBV as part of the Alumni in Action Programme. We look forward to meeting you. Below are a series of quick questions that will give us the information we need to send you more information about the programme so that you can make an informed decision about participating further in the programme.

If you have any questions please do not hesitate to contact Yumna Seadat on 0216503530 or email yumna.seadat@uct.ac.za

1.Are you physically located in South Africa?

Yes

2.Are you a registered psychologist/clinical social worker?(Required.)

Yes

3.Do you have experience in working with Trauma and Stressor-Related Disorders?(Required.)

Yes

4.Please provide your Practice Registration Number(Required.)

5.What is your area of psychology expertise?

Depressive Disorders

Anxiety Disorders

Trauma and Stressor-Related Disorders (such as post-traumatic stress disorder (PTSD), acute stress disorder, and adjustment disorders)

Substance-Related and Addictive Disorders

Other (please specify)

6.Do you have experience in the following areas?

Sexual Violence Trauma

Complex Trauma

None of the above

Other (please specify)

7.What therapy interventions and techniques do you use with your practice?

8.What modality are you able to conduct your practice?

Only online (Zoom, Google Hangout, Skype)

Only in physical consultation rooms

Online and/or physical sessions are possible

9.Are you available to attend either physical or online training (approximately 5 hours)

Yes

10.Please provide your contact details so that we can send you further information via email

Name

Company

Address

Address 2

City/Town

State/Province

Email Address

Phone Number

11.Please upload your CV. Please note that the CV must be of the person who will be providing the sessions to survivors.

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