Expression of Interest Capture Form

Enrolment Form

Personal Details

First Name(s)

Surname

Date of Birth

Pronouns (optional)

Other (preferred pronouns)

Address

Town/City

Postcode

Email Address

Validate Email Address

Phone Number

Can we leave a message at this number?

Yes No

Select all that apply - How would you like us to contact you?

Email
Phone
Text/SMS
Post

Emergency Contact

Emergency Contact Name

Emergency Contact Number

Emergency Contact Relationship

About Your Learning

Which is your preferred type of course?

face-to-face
online
no preference

Would you like us to send you a tutorial on how to use zoom?

Yes No

Would you like to speak with the Student Support Team to create an Individual Learning Plan (ILP)?

Yes No

Is there anything else you would like to tell us that would enable us to support you with your learning?

Yes No

If yes, please specify here, or let us know if you would like a meeting with Student Support to discuss further

Here are some examples of conditions or difficulties that you might want extra support with:

Mental health condition, substance misuse, visual or hearing impairment, mobility issues, difficulty with reading and writing, speech and language issues, English language proficiency, neurodiverse (eg: ADHD, autism spectrum, dyslexia, dyscalculia).

Which category best fits your situation?

Please specify organisation

Other (category)

Privacy Notice

This privacy notice is issued by Mind Recovery Net and can be read via the link: https://mindrecoverynet.org.uk/privacy/

The information that you provide will be used in the following ways:

When booking onto courses - to send you booking information and pre-course information.
Marketing materials including - prospectus and timetable updates, upcoming courses and Student Voice information.
Your information is held on a secure database and is never shared with third parties. For any further information around the protection of your data please read https://mindrecoverynet.org.uk/privacy/
We will ask you for basic demographic information including your name, contact details and emergency contact information.
You can also choose to share further information about any disabilities related to your learning needs.
The enrolment does not include an assessment of your mental health. This is something that health care professionals can help you with, if it is relevant to your time as a student with us.
Enrolment at the college is voluntary and you can end your enrolment with us at any time.

For further information about Data Protection please see the Hampshire and Isle of Wight NHS Foundation trust, found here https://hiowhealthcare.nhs.uk/privacy-notice We use MRN to help us administer your data at the Recovery College (see privacy policy above)

Learner Declaration

I confirm that I am over the age of 18

II agree to abide by the Recovery college charter. Click here to view charte Click here to view the charter

I understand that the Recovery College will store the information on this form and other information while attending the Recovery College subject to the provisions of the Privacy Notices mentioned above and the Data Protection Act 2018.

By submitting this form, I have read and understood the Privacy notices outlined by Mind Recovery Net, Recovery College and Hampshire and Isle of Wight NHS Foundation Trust, I have read and understood the Student Charter as outlined in the Recovery College Prospectus page 20. I agree to all and confirm that the information given on this form is true, complete and accurate. I accept that if this is not the case, the Recovery College shall have the right to cancel my application.

Monitoring Information

What is your ethnicity?

Other (Ethnic origin)

What is your gender identity?

Other (gender identity)

Sexual orientation

If 'other' please specify (sexual orientation)

Same gender as assigned at birth?

Yes No Prefer not to say

Are you currently, or have ever, served in UK Armed Forces?

Yes No