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CIS-A2K Covid-19 Counselling Support
As part of its ongoing program to support Wikimedians in India during the COVID 19 pandemic, CIS-A2K will provide support with access to counselling services to community members, in order to address mental health concerns resulting from the stress and anxiety of coping with the pandemic. The details on this form will help us process and share your application for counselling support under this programme.
Please do read this meta page carefully before filling the form -
https://meta.wikimedia.org/wiki/COVID-19_support_for_Wikimedians/India/COVID-19_Support_towards_Mental_Health_Care_and_Counselling_Services
All data collected here will kept confidential, and only used to share applications with our collaborators, Institute of Psychological Health.
For any query please email
wmwm@cis--india.org
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* Indicates required question
Please share with us your username. (For example, User:ABC)
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Your answer
Please share your mobile number
Your answer
Please share with us your affiliation to Wikimedia projects in India. (For example, user group, language community etc. )
Your answer
What is your preferred language for the counselling sessions? (As of now, counsellors are available in - Bengali, English, Gujarati, Hindi, Kannada, Konkani, Marathi, Punjabi, Sindhi, Tamil and Telugu)
*
Your answer
Do you consent to us sharing data collected here with our collaborators (IPH), and for them to contact you regarding counselling support ?
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Yes
No
Other:
How would you prefer IPH to contact you? (Email/Phone/Video-conferencing platforms such as Zoom/Jitsi/Meet etc; please share relevant contact details of the same.)
*
Your answer
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