Application for MGA Employee Assistance ProgramApplication for MGA Employee Assistance Program Use this form to apply for the MGA Counselling Services Employee Assistance Program.Once this form is received, one of the MGA team will be in touch to finalise the process and answer any further questions you might have. If you have any problems completing the form, please contact Matt Glover on 1300 38 50 20.For more information about the program, visit the EAP page by clicking here. Company/Organisation Name * Only employees and other agreed parties connected to this company/organisation will be eligible for the Employee Assistance Program Company/Organisation Address * Company/Organisation Postal Address * Company/Organisation Phone Number * Company/Organisation Email * Company/Organisation Website What does your company/organisation do? * Number of Employees * Name of Company/Organisation Director * Name of Company/Organisation Director First Name First Name Last Name Last Name Director Email * Director Phone * Accounts Person Name * Accounts Person Name First Name First Name Last Name Last Name Accounts Person Email * Accounts Person Phone * Number of counselling sessions per employee per calendar year required * The fee per counselling session is $200, inclusive of GST.EAP Add-ons Requested Professional Supervision Family members of employees included Couples Counselling BYO Counsellor (Additional $50 admin fee per invoice) Critical Incident Debriefs (Additional Charge) Team Days (Additional Charge) Professional Development Training (Additional Charge) Advanced Payment (Pay ten sessions upfront to reduce admin time) None requiredOptional add-ons are available to customise your Employee Assistance Program. Some add-ons attract an additional charge if used. Team days, professional development workshops and critical incident debriefs are charged by negotiation. Any Other Information? If there is anything about your organisation or it's recent history that might be helpful for us to know, please give a brief summary here. Once we have received your form:We will arrange a phone call to introduce ourselves (if that hasn't happened already) and to clarify any information we need to from your application form. An invoice for the $250 establishment fee will be sent to your accounts person. Once this is paid, posters for your workplace noticeboards and contact cards for each employee will be printed and delivered.A unique and confidential email address will be issued for your employees to contact us on. Do not share this email address with anybody outside of your organisation. A memorandum of understanding and process letter will be sent through for your signing. Submit If you are human, leave this field blank. Δ
