Eye to Eye Young People’s Counselling Service

Application for Volunteer Placement

Personal Details

Name:

DOB:

Address:

Contact Details

Home Contact Number:

Mobile Contact Number:

E-mail:

Current Employment Details

Employer Name:

Address:

Date started:

Please give a brief description of your duties:

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Eye to Eye Young People’s Counselling Service

Counselling Qualifications and Experience (Please include colleges/university and dates)

Please tell us about any relevant experience of working with young people

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Eye to Eye Young People’s Counselling Service

Please tell us the reason(s) you would like to volunteer with us at Eye to Eye Young People’s Counselling Service and what you feel you could offer our clients and charity? Please include your preferred theoretical model

Signed:______Date:______

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Eye to Eye Young People’s Counselling Service

Please provide names and contact details of two referees (Counselling students will need to include their current tutor).

Name:

Job Title:

Contact Details:

Name:

Job Title:

Contact Details

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Eye to Eye Young People’s Counselling Service

Our Community Bases

We currently have the following community base rooms across RCT and Merthyr. These settings are susceptible to change and the charity is always looking at ways to expand the community counselling venues within the boroughs.

Please indicate the community base(s) that you are able to travel to…

1. CEC, Bryncelynnog

2. Cwm Cynon Hospital, Mountain Ash

3. Y Pant School,

4. Community School, Aberdare

5. Valley’s Kids,

6. Keir Hardie Health Park, Merthyr Tydfil

Do you have access to a car? Yes/No

Are you able to travel throughout RCT and Merthyr? Yes/No

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