Use the same application for all the courses

Ursuline Center for Counselling and Psychotherapy
#134 Udayagiri, Mysore Karnataka
Ph: 0821 2452604 Mobile: (+91) 9743468821 and 73534558103
Website :
Email : [email protected]
For The Four-Week Counsellor Training Programme
(May be down-loaded from our website)
The Counsellor Training Programme the duration is four weeks. (Fee is Rs.10 500). Dates: April 14th to
May 12th 2015
NAME (in Block Letters) (Please indicate your Title as Mr./Ms./Fr./Sr./Br./etc)
Date of Birth _______________Age ______Gender _________Religion ________________
Complete Postal Address: (in CAPITAL LETTERS):
_______________________________________________ _______________________________________
-----------------------------------------------------------------------------------PIN code: -------------------Phone No: ______________________
Cell No: ________________________
E-mail ID: _________________________
Kindly draw a Demand Draft (DD) for Rs.500/towards the Registration Fee, in favour of “The
Director, Mariavidyanivas” -- payable at Mysore,
and send it along with this application form.
The envelope may be addressed to: Director
Maria vidya Nivas #134 Udayagiri, Mysore 570
019 Karnataka
Your Signature…………….
DD No.