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Request for Further Hours of Approved Counselling This form should only be used by applicants who have already received their initial 2 hours of counselling. Note: Fields with light yellow background are mandatory       Please enter full name of person requiring further counselling: Please enter Victims Services claim number: Please enter the name of your current approved counsellor: I hereby apply for additional hours of counselling pursuant to section 31 of the Victims Rights Support Act 2013. I am aware that the contents of my counselling session may be used in the preparation of a report to Victims Services for the purposes of subsequent counselling and/or applications for support. Please enter full name of person completing this form Dated 12/16/2019 If you have completed this form on behalf of the applicant, please enter reasons. BEFORE PRESSING THE SUBMIT BUTTON, we recommend that you print this web page for your records.