You can always press Enter⏎ to continue
2023 KOSTA 개인 상담 신청서
안녕하세요! 상담 신청을 위한 중요한 질문들이오니 잘 읽고 답변해주세요.
START
1
Waiver of Liability (상담 동의서)
*
This field is required.
The undersigned, seeking a biblical life coaching adhered by KOSTA/USA, hereby acknowledges his or her understanding of the following conditions and further releases to the life coaching program, its mentors, and staffs, from any liability or claim arising from the undersigned’s participation in the above-mentioned the life coaching program: 1) It is understood by the participant that the life coaching program will be provided by supervised mentors, not as licensed therapists; 2) That all programs provided during KOSTA Conference is in accordance with the biblical principles adhered to its ministry and are not necessarily provided in adherence to any local or national psychological or psychiatric association; 3) That no representation has been made, either expressly or implied, that the life coaching, as conducted by the mentors, is accepted as customary psychological and/or psychiatric therapy within the definitional terms utilized by those professions. 4) Certain statements may not be protected as privileged communications under law. Do you agree with Waiver of Liability?
YES
NO
ㅜㅜ
Next
Submit
Press
Enter
2
I hereby agree to the following conditions:
*
This field is required.
1) I assure to keep confidential information from the mentoring session. (저는 세션 중 거론된 상담가의 정보 포함, 개인적인 내용은 비밀로 지키기로 약속합니다.) 2) I am committed to resolving/adjusting/rectify my problems by coming into obedience to the Word of God. (저는 세션 중 거론된 문제를 하나님의 말씀인 성경 안에서 풀어나가기로 약속합니다.) 3) If I am dissatisfied in any way with the session, I will first discuss it with the program staff directly. (세션의 결과에 불만이 있을 경우, 상담실 스태프와 먼저 상의를 먼저 할 것을 약속합니다.) 4) Mentors and mentees have a right to report the session if they notice severe life-threatening situation. (상담가와 내담자는 세션 중에 생명에 지장이 있는 응급상황이 감지될 경우 관련 기관에 신고할 수 있는 권리가 있습니다.) *** If you have any questions about these guidelines, please consult with the KOSTA staff or one of our mentors. (위의 내용에 질문이 있을시에는 상담실 스태프나 상담자님께 상의해주시면 감사하겠습니다.) I, (아래 자신의 이름 서명), affirm the accuracy of the personal information provided herein, and have read the information above and agree to the conditions set forth therein that the life coaching I receive will be based on the mentor’s understanding of the Bible as the Word of God and its practical applications.
ㅜㅜ
Next
Submit
Press
Enter
3
성별
*
This field is required.
Gender
남(male)
여(female)
ㅜㅜ
Next
Submit
Press
Enter
4
이름
*
This field is required.
Name
ㅜㅜ
Next
Submit
Press
Enter
5
나이
*
This field is required.
Age
ㅜㅜ
Next
Submit
Press
Enter
6
조번호
*
This field is required.
Group #
ㅜㅜ
Next
Submit
Press
Enter
7
상담실에서 연락받을 e-mail address
*
This field is required.
ㅜㅜ
Next
Submit
Press
Enter
8
상담실에서 연락받을 전화번호
ㅜㅜ
Next
Submit
Press
Enter
9
희망상담가
*
This field is required.
Preference of Counselor
Male / 남자상담가
Female / 여자상담가
No preference / 상담실추천
Other
ㅜㅜ
Next
Submit
Press
Enter
10
희망 상담 시간-2순위
*
This field is required.
Preferred Time to Meet
화요일 오전 (LGS 시간)
화요일 오전 (오전 전체집회 끝부분 & 점심식사 시간 일부)
화요일 오후 (세미나 1)
화요일 오후 (브아시간)
화요일 오후 (세미나 2)
수요일 오전 (LGS 시간)
수요일 오전 (오전 전체집회 끝부분 & 점심식사 시간 일부)
수요일 오후 (세미나 1)
수요일 오후 (브아시간)
수요일 오후 (세미나 2)
목요일 오전 (LGS 시간)
ㅜㅜ
Next
Submit
Press
Enter
11
개인 상담 세션 운영을 위해서 많은 노력과 인력이 요구됩니다. 꼭 상담이 필요하신지 확실하지 않다면 코스타 컨퍼런스 기간 동안 현장에서 운영되는 멘토링을 통해서 고민하시는 부분에 대한 도움을 받으실 수 있습니다. 또한 개인 상담 신청을 접수하신 후 상담가님과 매칭되신 후에는 상담 세션을 취소하거나 시간을 변경하실 수 없습니다. 이에 동의하며 신청서를 계속해서 작성하시겠습니까?
YES
NO
ㅜㅜ
Next
Submit
Press
Enter
12
전문 상담, 심리치료를 받으신 적이 있으신가요?
*
This field is required.
Have been treated for a psychiatric, emotional, or mental illness?
YES
NO
ㅜㅜ
Next
Submit
Press
Enter
13
코스타 상담실에서 상담을 받으신 적이 있으신가요?
*
This field is required.
Have you ever experienced the KOSTA life coaching?
없음 (None)
1회 (Once)
2-3 회 (2-3 times)
4회 이상 (More than 4)
ㅜㅜ
Next
Submit
Press
Enter
14
YES라고 답하셨다면 어떤 일로 상담을 받으셨나요?
ㅜㅜ
Next
Submit
Press
Enter
15
원하는 상담 분야
*
This field is required.
Desired KOSTA life coaching topics
관계 (Relationship)
중독 (Addiction)
내적치유 (Inner Healing)
정신 건강 (Mental Health)
정신 질환 (Mental Disorder)
바운더리 (boundery)
성격 문제 (Personality Issues)
감정 제어 (Emotional Disregulation)
집중 장애 (Distraction)
다문화 문제 (Multicultural Issues)
가정 불화 (Family issues)
Other
ㅜㅜ
Next
Submit
Press
Enter
16
상담분야-진로
Career Issues--원하는 상담분야에서 진로를 선택하셨을 경우 작성해 주십시오.
진로 선택 (Career Choices)
소명
대화하기 원하는 특정 분야가 있다면 표기해 주십시오.
Other
ㅜㅜ
Next
Submit
Press
Enter
17
예전만큼 사람들과 어울리는 것이 즐겁지않다.
*
This field is required.
I don't enjoy being around people as much as I used to.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
18
내 자신이 가치없게 느껴진다 (내 존재가치를 발견하기 어렵다.)
*
This field is required.
I feel worthless (I don't find much value in myself).
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
19
내 삶의 소망이 없다고 느껴진다 (내 삶의 미래가 잘 보이지않는다.)
*
This field is required.
I feel hopeless (I don't see a future in my life).
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
20
나는 고립되어 있고 외롭게 느껴진다.
*
This field is required.
I feel isolated and alone.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
21
나는 슬픈 날이 그렇지 않는 날보다 더 많게 느껴진다.
*
This field is required.
I feel sad more days than not.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
22
나는 생을 마감하고 싶은 생각을 한다.
*
This field is required.
I have thoughts of ending my life.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
23
나는 수면 문제를 겪고 있다.
*
This field is required.
I have sleep difficulties.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
24
나는 평소 걱정을 멈추는 것이 어렵다.
*
This field is required.
I feel like I can’t turn my mind off.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
25
나는 극심한 압박이나 공포를 느낀다.
*
This field is required.
I have spells of terror or panic.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
26
큰 이유없이 심장이 뛴다.
*
This field is required.
My heart races for no good reason.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
27
나는 자주 긴장상태에 있다.
*
This field is required.
I feel tense.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
28
나는 사람들이 나를 좋아하지 않을 것을 염려한다.
*
This field is required.
I am concerned that other people do not like me.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
29
나는 사람들의 시선을 의식한다.
*
This field is required.
I feel self-conscious around others.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
30
나는 모르는 사람들과 만나는 자리를 가급적 피한다.
*
This field is required.
I avoid a situation where I am surrounded by people I don't know.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
31
나는 최근 평소만큼 집중이 잘 되지 않는다.
*
This field is required.
I am not able to concentrate as well as usual.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
32
동기부여 되는 것이 어렵다.
*
This field is required.
It is hard to stay motivated.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
33
내 일을 지속하는 것이 어렵다.
*
This field is required.
I am unable to keep up with my work.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
34
내가 무엇을 하든지 잘 해낼 자신이 있다.
*
This field is required.
I am confident I can succeed in whatever I do.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
35
나는 내가 원하는 것이상으로 아래와 같은 행동을 떠올리거나 생각한다. (해당 사항 모두 선택)
*
This field is required.
I think about _____________ more than I would like to. (Check all that apply)
None
Disordered eating (섭식문제)
Internet Use (인터넷사용)
Game (게임)
Cell Phone (핸드폰사용)
Videos (동영상)
Alcohol (술)
Smoking (담배)
Drugs (마약)
Sexual life (성생활)
Shopping (충동구매)
Self-injurious behavior (자해)
Other
ㅜㅜ
Next
Submit
Press
Enter
36
나는 아래와 같은 행동을 할때 통제가 되지 않음을 느낀다. (해당 사항 모두 선택)
*
This field is required.
I feel out of control when I _____________. (Check all that apply)
None
Disordered eating (섭식문제)
Internet Use (인터넷사용)
Game (게임)
Cell Phone (핸드폰사용)
Videos (동영상)
Alcohol (술)
Smoking (담배)
Drugs (마약)
Sexual life (성생활)
Shopping (충동구매)
Self-injurious behavior (자해)
Other
ㅜㅜ
Next
Submit
Press
Enter
37
나는 아래와 같은 행동을 한 후에 종종 후회하곤 한다. (해당 사항을 모두 선택)
*
This field is required.
I often regret after _____________. (Check all that apply)
None
Disordered eating (섭식문제)
Internet Use (인터넷사용)
Game (게임)
Cell Phone (핸드폰사용)
Videos (동영상)
Alcohol (술)
Smoking (담배)
Drugs (마약)
Sexual life (성생활)
Shopping (충동구매)
Self-injurious behavior (자해)
Other
ㅜㅜ
Next
Submit
Press
Enter
38
나는 술을 마시면 무슨 일이 있었는지 기억이 나지 않는다.
*
This field is required.
When I drink alcohol I can't remember what happened.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
39
내 성질/화를 통제하는데 어려움이있다.
*
This field is required.
I have difficulty controlling my temper.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
40
나는 쉽게 화가 난다.
*
This field is required.
I get angry easily.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
41
나는 말다툼에 자주 개입된다.
*
This field is required.
I frequently get into arguments.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
42
나는 가끔 물건을 부수거나 치고 싶은 생각이 들곤한다.
*
This field is required.
I sometimes feel like breaking or smashing things.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
43
나는 내가 나를 통제하지 못해서 폭력적인 행동을 할 수도 있다는 두려움을 느끼곤한다.
*
This field is required.
I am afraid I may lose control and act violently.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
44
나는 다른 사람을 해치고 싶은 생각을 한다.
*
This field is required.
I have thoughts of hurting others.
Not at all like me
Somewhat not like me
Neutral
Somewhat like me
Extremely like me
ㅜㅜ
Next
Submit
Press
Enter
45
개인상담 매칭과 상담 장소 연결은 로비에 있는 상담데스크를 방문해주셔야 완료 됩니다. 모든 연락은 신청서에 알려주신 개인 이메일로 보내드립니다.
*
This field is required.
개인 상담 세션은 LGS, 세미나, 브아 시간에 동일하게 진행이 됩니다. 희망 상담 시간에 스케줄 컨펌이 되지 않을 수 있으며, 세미나 혹은 브아 시간에 매칭이 될 경우 개인 상담 세션이 우선이 되어 미리 신청하신 세미나/브아 세션에서 제외 되실 수 있음을 알려드립니다.
YES
NO
ㅜㅜ
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
45
See All
Go Back
Submit