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Name & surname |
Gender (M/F) |
Basic qualification |
Counselor training attended (if any) |
Front desk, VCT counselor (health
professional/non health professional) specify
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TOTAL amount due E___________________
It is a requirement that all participants attend
all sessions of the course.
Disclaimer
It must be understood that this short HTC/VCT
course provides training for pre and post HIV test counseling only.
This course does not adequately prepare counselors for managing the
complex clinical, psychological or psychosocial issues that occur
across the disease continuum
Name of manager/ officer filling the form
Position in organization
.
Signature
Contacts: telephone
(w)
Mobile
Email
.
DATE:dd
mm
yy
Organizational
stamp
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