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Capacity Development Questionnaire

Please click Start below and answer the first question, THEN CLICK THE "NEXT" BUTTON TO MOVE TO THE NEXT QUESTION.

As a requirement for admittance to the Capacity Development program you must answer every question.

When you have completed the questionnaire you will see a Restart button, which you can click if you want to go back and change any of your responses. 

Click the button below to start.

Start

Question 1 of 8

Please share your name, email address, and phone number, indicating the best way to reach you. 

Question 2 of 8

What would you like to get from the Capacity Development Program? 

Question 3 of 8

How much and how frequently do you currently use drugs and alcohol? 

Question 4 of 8

Do you have any history of emotional instability? Please explain. 

Question 5 of 8

Is there any danger that accessing pain or childhood memories could be destabilizing for you? 

Question 6 of 8

Have you been hospitalized for psychiatric reasons or treated with psychiatric drugs? Are you currently on any psychiatric drugs? 

Question 7 of 8

Are you currently in psychotherapy? For how long? 

Question 8 of 8

If you were in emotional difficulty or felt like you were falling apart, where would you turn? 

Confirm and Submit