First Name

Surname

Address

Preferred Phone Number

Email Address

What was the name of your course?

What is your level of qualification?

What was the name of your institution or training provider?

When did you complete your course?

Have you had any personal therapy? Was this a requirement of your course?

Which counselling/psychotherapy professional body are you a member of?

Why would you like to volunteer as a counsellor with West Mercia Women’s Aid?

Relevant experience: please tell us about any work or voluntary experience you have had which is relevant to counselling and/or working with victims and survivors of domestic abuse.

Availability: which of our locations would you be able to work from? Availability: which of our locations would you be able to work from?HerefordWorcestershireKidderminsterTelford

Availability: what days would you be available to work and how many hours could you offer per week? (Please note that our service operates Monday-Friday 9-5)

When would you be available to start? (Please note we ask for a minimum commitment to our service of 12 months.)

Do you have any physical or mental health issues we should be aware of, or is there any action WMWA would need to take in order to keep you safe and comfortable when you volunteer?

Do you have any unspent criminal convictions or proceedings pending?

Name

Address

Phone

Email

Relationship to you

Name

Address

Email

Phone

Relationship to you

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Agreement to use my data. Agreement to use my data. By ticking this box I give consent to WMWA to store and process my personal data relating to my volunteer application.