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PARTNER RAPE
IS

REAL RAPE


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FAITH-BASED COUNSELLING SERVICES DATABASE INPUT FORM

Please use the form below to put information about your service into this Database.
Your information will appear when you have submitted it and filled in the CAPTCHA Spam-preventer.
Please note that you need to check the box that asks if you understand considerations about IPSV for your type of service (available here)
but you may leave any other field blank if it is not relevant.
However, please fill in as much as you can to ensure that survivors have sufficient information about your service.

In asking about your qualifications, this is because survivors often need these details. Just as importantly though, while I believe that some level of qualification is essential when working with traumatized people, the level of qualification often matters less than the counsellor's ability to work well with sexual assault and domestic violence clients.

Thank you so very much for your assistance with this project.

You understand special considerations for IPSV survivors?
Service Name:
Service Website Address?:
Country:
State/County/Region:
City:
E-mail Contact (if appropriate):
Phone Contact incl. area code (if appropriate):
Is there a Free Crisis Number?
Hours of Service Availability (Crisis Line, other; if different services/hours, start new line for each).
Cost of Services (please choose):
If costed do you wish to elaborate (for example, can a client get reduced costs if she has a referral)?
What types and modes of counselling does your service offer i.e. Crisis, short-term, long-term, telephone, face-to-face, email, online chat?
Counselling Approaches Used i.e. CBT, Psychodynamic, Feminist-based, Combination (Please elaborate)
Other Services Offered i.e Police advocacy, referrals, liaison with other community resources for abused women (Please elaborate):
Do you have a message of outreach for IPSV survivors who may seek out your service?
Other information about your service you think is necessary?


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