Applications – Kenya Institute of Professional Counselling

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1 APPLICATION FORM

2 CLIENT INTAKE FORM

3 ATTACHMENTS

CLIENT INTAKE FORM (for Student Therapy: Skip this form if it is not applicable to your course)
Students joining Certificate and Diploma in Psychological Counselling are entitled to 5 and 15 subsidized counselling sessions consecutively as they meet an important course requirement. The sessions are a critical part of licensing, accreditation and learning. Information shared here just like in page one is secured and treated with utmost confidentiality. The information collected here helps us identify a counsellor whose portfolio speaks to the realities of your personal needs at this time
Personal information
Title Name & Mobile Religion Age Nationality
Marital Status
Have you been previously counselled?
Rewrite your response in the box
Yes No if yes by whom (Name and Title)
Issue (s) of concern
Are you aware of specific issue you can share with your therapist? Susan Gilmore, one of the psychological minds summarizes issues to take for counselling into three pillars; Relationship, work, Identity. Rewrite or type your concern
Preferred Counsellor
See the details that makes you comfortable
Day and time of the week when available for therapy
Do not overthink about it because you will mutually agree with your counsellor on what works best for the two of you once you have been assigned a contact.
Will you rather have your sessions online or on-site ?

APPLICATION FORM (for Academic Purposes)