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XIAC Application Form for Offline Course at Premanjali:
From: 4th January to 29th March 2025
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Email
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Name Of Applicant(Surname first) :
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Gender Of Applicant :
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Male
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Other:
Age (Completed years) :
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Address :
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Contact Number :
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Date of Birth:
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Email id :
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Marital Status :
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Profession :
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If Priests\Religious - kindly mention the Name of your Congregation\Diocese :
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Post Graduation: Mention Year , Degree Name, University Name:
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Graduation : Mention Year, Degree Name, University
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Any Special courses in Counselling\Psychotherapy : kindly specify the details if any.
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If working - kindly specify - Name of Organization, Address and Contact number :
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If you have had any professional experience in counselling - kindly specify the following details: Organization name and address, Nature and Duration of experience :
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Health Status - kindly indicate if you have any physical, physiological, emotional or mental health problems/conditions :
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On Medication - Indicate the medications you are currently taking and for what purpose:
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Reasons for attending this course :
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Your expectations of the training you wish to undergo?
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Areas you would like to have greater attention given to in this training?
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How will you use the training you are planning to undergo?
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What are your limitations in attending this course?
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