Application form for 'Time for Mind Care!' program
This program is mental health and human rights education. Session will be held via Zoom.
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Date of Education(choose either date) *
Name *
Birth Date *
MM
/
DD
/
YYYY
Sex *
Country of Origin *
Contact (Phone Number) *
Address(you don't have to write full address. ex: Seoul, Mapogu, Sunsandong) *
Consent to collection and use of personal information *
According to related laws such as the Privacy Act, the Global Diaspora Multicultural Coaching Network receives consent for the use of personal information collection and utilization. It is not used for any purpose other than the contents agreed by the personal information provider, and if you want to refuse to use the personal information provided, you may request the person in charge of personal information management to read, correct, or delete it.                                                                                                                                      [Personal Information Collection List]  : Name, Birth Date, Address, Contact, Country of Origin                                                                                                           [Personal Information Collection Purpose] : Collection of personal information to carry out the program
Required
Signature(Write your name.  ex: Sara Strong) *
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