Enrolment Form

We are delighted you are interested in taking part in courses within our Recovery College.

Please complete the following enrolment form in full to enable us to assist you in your journey. Your details will be added to our database but will not be shared without your permission.

Inclusivity is both at the heart and forefront of everything we do at the Recovery College. We welcome everyone with kindness and compassion. We value you for your uniqueness, individuality and encourage you to be you. You are not defined by any label but celebrated and empowered to be true to who you are.
There is only one you. Embrace, accept and be heard

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Your Details

Student Contact Details

Preferred Title

Preferred Title - please specify

Preferred First Name

Preferred Surname

Legal Title Required

Legal Title - Please specify

Legal First Name Required

Legal Surname Required

Address Required

Post code Required

Email Address Confirm email

Date of birth

Age

Home Phone

Mobile Phone Required

Work Phone

NHS Number

Who should we contact in an emergency?

Emergency contact name Required

Relationship to student Required

Emergency contact phone number Required

Equal opportunities

We'd love to know...

How did you find out about us?

How did you find out about the Recovery College?

BCHFT Publications

BCHFT Staff

BCHFT Web site

Recovery College Literature

Recovery College Student

Other Community Organisation

Other (please specify)

Please provide more information below, such as the staff member and/or the service/organisation

How did you find out about the Recovery College - please specify

A little more about you

Which of the following currently applies to you? Please tick all relevant boxes

Accessing Services

Carer Supporter

Family Member or Friend

Volunteering in Mental Health

Improve Mental Wellbeing

BCHFT Student Placement

Working in Mental Health

BCHFT Staff Member

Other

Do you feel that you have a disability? A disability is a physical or mental condition that has a long term negative affect on your ability to live your life.

Do you have any other specific needs that could affect your learning?

Do you have anybody involved in your care that you would like to support you in the college? Please give details

Are you currently accessing any mental health service(s) from Black Country Healthcare NHS Foundation Trust? Or on a waiting list to access a service? Please give details below

What is your current housing situation?

Home Owner

Renting

Experiencing Homelessness

Supported Accommodation

Living With Family

Other

Have you a supporter/worker who helps you? (Care co-ordinator)

Care co-ordinator name

Care co-ordinator title

Care co-ordinator contact number

Care co-ordinator organisation

Are you happy for us to contact this person in case of an emergency?

Employment & Education

Education

What is your highest level of education that you hold? Please tick all relevant boxes

None

Primary Education or Equivalent

Lower Secondary Education or Equivalent

Upper Secondary (NVQ Level 2, GCSE/CSE/GNVQ)

Post-Secondary Education (Higher Education, AS/A2/A Levels, NVQ Level 3)

Tertiary Education (NVQ Level 4-5, Degree, Post Graduate Diploma

Employment

Have you served in the armed forces? Required

Yes

Are you a family member of a veteran or serving personnel?

Yes

One Last Thing!..

Technology

What access to digital technology do you have? Please tick all relevant boxes

Wifi/Internet Access at Home

Smart Phone

Tablet/iPad

Laptop/Computer

Email Address and Able to Use

Data Protection & Consent

I Understand that the information that I provide will be held in accordance with UK-GDPR and the Trusts Data Protection and Information Governance Policies and procedures.

I Understand that the service will contact me regarding my application and that i may also be required to take part in the evaluation of my experiences at The Recovery College which will include the completing of surveys and talking about my experience in a one to one telephone or face to face meeting. I agree that i can be contacted by the following methods. (Select all that apply)

Text Message

Post

SMS

We would like to reassure you that answering the questions on our Enrolment form will help us to ensure that the Recovery College will meet the needs of our students and we can deliver the best possible service to you

The Recovery College will use the information you have provided on this form to ensure that everyone has the same opportunity to gain a sense of belonging and feel valued during their recovery journey. 

Your information enables us to identify resources, services and support that will be of interest to you and to make certain that our courses and activities are of the best possible quality and are accessible to everyone. 

Once you have submitted this enrolment form, we will contact you to book an “Information and Guidance” and a “Getting to Know You” session. After these sessions you can enrol on any courses of interest.