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: 1 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 2 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:_________________ 3 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 4 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. Beddau CEC, Bryncelynnog 2. Cwm Cynon Hospital, Mountain Ash 3. Y Pant School, Pontyclun 4. Aberdare Community School, Aberdare 5. Valley’s Kids, Penygraig 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 5 .