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心命樹教研學院 Psychological Wounds Institute (PWI)

Application Form

Part A: Personal Particulars

Full Name: Mr./Ms.*___________________________ (English) __________________(Chinese)

Name of Organization: ___________________________________________________________

Position: ______________________________________________________________________

Field of service: ________________________ Years in field: __________________________

Years of case work experience: ____________________________________________________

Email: ________________________________________________________________________

Contact no.: _________________________(Office) ___________________________(Mobile)

*Please write in capital letter, the name will be printed on the certificate.

Acknowledgment: I acknowledge that I have read and agreed to the application guidelines.

Signature: ___________________________ Date: ____________________________

Part B: Course Selection Please put a “” inside the selected box(es). Advanced course could “” more than one.

Step 1 Step 2 Step 3 CORE COURSE

(Choose 1 from 6 options)

HKD$1,000

ADVANCED COURSES (Choose 1- 3 options)

REFLECTIVE WORKSHOP

(Choose 1 -2 options)

GOS-Cor-1 Date & Time: 17 & 24 Oct 2017, 10:00-13:00 & 14:00-17:00

ADV1-2 (TWO days training) Sensitivity, Intuition and Emotional Connection with Clients with Traumatic Experiences: An Initial Articulation Trainer: Prof. Kam-shing YIP Date & Time: 7 & 28 Nov 2017, 10:00-13:00 & 14:30-17:30

Fee:

$2,400

$2,200(joining with 1 more friend:______________ (name) $2,000(joining with 2 more friends:____________(names)

This workshop is only applicable to applicants who have applied for the Core course and Advanced Course(s). Please use a “”to show your preference of joining the workshop.

GOS-Cor-2 Date & Time: 13 & 20 Nov 2017, 10:00-13:00 & 14:00-17:00

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GOS-Cor-3 Date & Time: 25 & 26 Jan 2018, 10:00-13:00 & 14:00-17:00

ADV3-4 (TWO days training)

Duality, Intimacy, Emotionality, Dignity and Resilience of

Intergenerational Trauma: An Initial Articulation and Intervention

Trainer: Prof. Kam-shing YIP Date & Time: 5 & 19 Dec 2017, 10:00-13:00 & 14:30-17:30

Fee:

$2,400

$2,200(joining with 1 more friend:______________ (name) $2,000(joining with 2 more friends:____________ (names)

GOS-RW1 Content: To reflect the training of ADV1-2 & ADV 3-4.. Date & Time: 16/1/2018, 10:00-13:00 & 14:00-17:00

GOS-Cor-4 Date & time: 8 & 9 Feb 2018, 10:00-13:00 & 14:00-17:00

GOS-Cor-5 Date & Time: 10 & 11 May 2018, 10:00-13:00 & 14:00-17:00

ADV5-7 (THREE days training) Arts Heal the Invisible Wound Trainer: Ms Fiona CHANG Date & Time: 28, 29, 30 May 2018, 9:30-17:30 Fee: $3,600 $3,300(joining with 1 more friend:______________ (name) $3,000(joining with 2 more friends:____________ (names)

GOS-RW2 Content: To reflect the training of ADV5-7. Date & Time: 27/6/2018, 10:00-13:00 & 14:00-17:00

Application for Exemption (the

result is to be

confirmed by

PWI)

Remarks: (1) The training fee of Core Course (HK$1,000) could be deducted if joining the advanced course(s) at

the same time. (2) Participants should provide the full name(s) of your friends for enjoying a discounted fee. (3) Participants, who have more 5 years or above casework experience and completed trauma-related

programmes, could apply for the exemption of joining the Core Course. For applying the exemption, provision of evidences is needed. Please email us the subject as “Application for exemption of Core Course__(YOUR NAME)”; and state your reasons with supporting document(s) via email/fax at least 2 weeks before the course started. We reserve the right to make the final decision of the captioned application.

Course Fee Calculation: Core course Advanced Courses

HKD$1,000 (without

joining advanced course)

HKD$0 (with joining advanced

course at the same time, or applying for exemption

of Core Course.)

ADV1-2 $2,400 $2,200 $2,000 ADV3-4 $2,400 $2,200 $2,000 ADV5-7 $3,600 $3,300 $3,000

Payment Information @ Bank Name: __________________________ __________________________ Cheque no.:________________

(A) $_____________ + (B) $_______________________ = Total (A+B): $______________

@ Please make cheque payable to “Caritas - Hong Kong (S.W.D.)” for each PERSON with the amount after discount deduction if any.

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Application Guidelines 報名須知

Enrollment and Payment Method 報名及繳費辦法 Applicants should complete this application form and submit with a crossed cheque (by mail or in-person; payable to

“Caritas - Hong Kong (S.W.D.)”) to 50 Kwon Tung Road, Kowloon, Caritas Family Crisis Support Center (Attention to: Applying for courses of Psychological Wounds Institute). 申請者填妥報名表格，連同以「香港明愛」抬頭之劃線支票，郵寄或親身遞交至 九龍觀塘道 50 號明愛向晴軒收 (信封請註明: 報讀心命樹教研學院課程)

Important Notes about Enrolment 報名注意事項 Course information can be downloaded from the following website: http://fcsc.caritas.org.hk and http://gos.caritas.org.hk. For

enquiries, please visit our website or contact us at 2383 2122. 如有任何疑問，可瀏覽本會網頁 (http://fcsc.caritas.org.hk and http://gos.caritas.org.hk) 或致電 2383 2122 向本中心查詢。

Acceptance of application is normally made on a first-come-first-served basis. Confirmation of application is announced via email 2 weeks before the commencement of the training. Please contact us if you do not receive any notification before the course starts (Tel: 2383 2122). 本中心一般以「先到先得」方式處理課程報名，申請結果將於課程兩星期前經電郵通知。申請者若在課程開課前仍未收到任何

通知，請與本中心聯絡 (電話：2383 2122)。

Payment is not refundable for withdrawal or absence from the enrolled programme. 無論申請者退出或缺席課程，已繳交之學費將不獲退還。

Receipt of application fee will be given on the first day of training. 收據會於課程之第一天派發。

A Certificate of Attendance will be given to participants who have attended at least 80% of the course. 出席率達 80%者可獲發該課程之出席證書。

Caritas Family Crisis Support Centre (CFCSC) reserves the right to make any changes to the course when necessary. CFCSC also reserves the right to cancel a course owing to insufficient enrollment or other special occasions, and to notify the applicants via email. Programme fee is refundable in such case. 如有需要，明愛向晴軒有權對課程內容及安排作出改變。本中心亦保留權利，在課程人數不足或其他特殊情況時取消該課程，

並以電郵通知申請者。經本中心安排後，申請者將獲退還該課程的費用。 I understand that the process of the programme(s) would be recorded. I agree that the photos and videos taken in the

programme(s) may be used on the internet and printed products for service promotion. 本人清楚知道整個活動過程會被攝影及攝錄，本人同意本中心把過程中拍攝的照片用於網站及印刷品，作為推廣服務之用。

If the black rainstorm warning or typhoon signal No. 8 is hoisted 3 hours before commencement, the courses will be canceled or postponed. CFCSC will inform participants the new arrangements. 若開課前 3 小時懸掛黑色暴雨警告或 8 號颱風訊號，該日課程將取消或延遲。 新的安排將日後通知參加者。

If the black rainstorm warning or typhoon signal No. 8 is hoisted during courses, CFCSC will decide whether participant should be evacuated, depending on the immediate situation. 若黑色暴雨警告或 8 號颱風訊號於課程進行中懸掛，本中心將視乎情況安排參加者去留。

The personal data provided on application forms are used by CFCSC only for enrollment and administration purposes. Under the provision of the Personal Data (Privacy) Ordinance, applicants have the right to request access to and make correction of their personal data. Applicants wishing to make amendments on personal data should submit written requests to FCEC by email to pwi@cfcsc.org.hk. 報名表所提交的個人資料，只供中心用作處理報名等相關事宜。根據個人資料(私隱)條例，申請者有權查詢及更改其個人資料。申請者如欲更改個人資料，請以書面方式提出申請，並電郵至 pwi@cfcsc.org.hk。