Schedule a meet and greet
Book an Initial Conversation
Please state the urgency of the help you need:
*
High emergency, In Crisis
Concerning, needing help ASAP
Low Priority
Full Name
First Name
Last Name
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Year of ALICT
*
Preferred Contact Method
*
Email
WhatsApp
Messenger
Other
Please propose a date and time that would suit you. Please note, counsellors are generally available Monday to Friday between 7:00-14:00.
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Please propose a second date and time, should your first choice not be available.
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Please write the name of the counsellor you would like to meet with.
Please include the name of a second counsellor in case your first choice is unavailable.
Briefly describe what brings you to counselling and what you would like support with.
Protection of Personal Information Act of 2013 (“POPI”)We are committed to protecting your privacy. Whenever you use our website, complete an application form, or contact us electronically, you consent to our processing of your personal information in accordance with the requirements of POPI. When submitting a counselling request form, your information will remain confidential and will only be shared with the counselling facilitator, project manager, and your preferred counsellors to ensure prompt responses to your initial meet and greet request. In the event that you wish to revoke your consent, please send an email to admin@itl.co.za.
Submit
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