홈으로 참여공간 bracket 상담신청 bracket 영어

영어

Consent to provide and use of personal information (required)

  • Personal information will not be used for any purpose other than counseling, if you want to refuse the use of the provided personal information, you may request to view, correct, or delete through requesting the in charge.
  • Collection items: All personal information registered in the consultation application
  • In accordance with the Personal Information Protection Act, etc. I agree to provide and use the personal information as above.

  Agree          Do not agree

  Mark is required

Name Contact No
Date of birth  달력 Occupation
Child  Have children         No children
Birth country Status of stay
(Visa)
Consultation content  Domestic violence         General violence         Sexual violence         Prostitution       
 Other ( )
Fill in the following content, only if you want to consult directly with a counselor
Consultation method  Telephone         Self-visit         Consultant visit         SNS (message)       
 Other ( )
Consultation Type  Domestic violence         General violence         Sexual violence         Prostitution         Marital conflict         Family conflict         Divorce problem         General law         Sojourn problems
 labor issues         Dating violence, Stalking         Psychological counseling
 Other ( )
Desired date and time for consultation calendar   

hour   minute

Please write the possible date and time for consultation visit

 Translation  Need         Not needed

** The date of application is automatically entered **

Counseling application and content of consultation are conducted in private.

Chungnam Counseling Center for Migrant Women Victims of Violence