West Mercia Women’s Aid Student Counselling Placement Application Form West Mercia Women's Aid > Forms: Student Counselling Placement Application Student Counselling Placement Application Form Please complete the form below Name Address Mobile number Email address Emergency contact Current Course Details: Please tell us what course you are enrolled on, what level it is at and what accreditation it has (if any). Have you had or are you having any personal therapy? Is this a requirement of your course? Other relevant training: Please tell us about any other relevant courses/training you have completed (include level, duration, course provider). Relevant experience: Please tell us about any voluntary or work experience you have had which is relevant to counselling work. What interests you about a student counselling placement at West Mercia Women’s Aid? Do you (or a close friend/family member) have personal experience of domestic abuse? If so, please provide brief details and give an indication of how recent this was. If you answered ‘yes’ to the above question, how do you think your experiences will impact on you when undertaking a placement with WMWA and how will you manage this? Are there any issues or experiences which clients may bring which you would NOT at this stage feel able to work with? Are you able to provide counselling in any languages other than English? If so, please give details. Availability: What days are you available to work at WMWA and how many hours could you offer per week? When would you be available to start a placement and how long would you ideally like it to last? Do you have Professional Indemnity Insurance in place? Do you have a current Enhanced DBS check in place? Please provide the certificate number. 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? We will treat typing your name in the box below as a digital signature. Send