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Consent to provide and use of personal information (required)

  • The center uses collected personal information only for counseling. If you would like to reject to use collected personal information, you could ask open, modify, delete through the manager.
  • Items to be collected : All personal information from this application
  • Follow 「Personal Information Protection Act」 etc, Do you agree to be collected personal information like below part?

  Agree          Disagree

  Mark is required

Name

Contact Information

Date of birth

Employment (JOB)

Do you have Children?

  Yes          No

Country of birth

Visa type

Content of counseling

 Domestic violence         Violence         Sexual violence         Sexual trafficking(prostitution)       
 Etc ( )

If you would like to have counseling in person, Fill this section.

Method of counseling

 By call         In center         Counselor visit         SNS(message)       
 Etc ( )

Type of content

 Domestic violence         General violence         Sexual violence         Sex trafficking(prostitution)         Married couplet         Family         Divorce         legal         Visa         Labor         Dating violence, Stalking         Psychological counseling
 Etc ( )

Available date for counseling

 Year     month     day

Please write the possible date and time for consultation visit

Do you need translator?

  Yes          No

** The date of application is automatically entered **

We ensure your information of application and counseling content confidentiality.

Chungbuk Counseling Center for Migrant Women