Enquiries Capture Form

Application Form - Your details

First Name

Surname

Gender

Date of Birth

/ /

Address

Town/City

Postcode

Email Address

Landline

Mobile

Please check this box if you DO NOT wish to receive course reminders via text/email

Where did you hear about the Recovery College?

If 'other', please specify (hear about us)

About You

Please indicate your current status

A current mental health service user (or within the last 12 months)
A former mental health service user
A Supporter/Carer
LPFT Staff
LPFT student on placement
Student studying in Lincolnshire
Member of the public
Other (please specify)

Other (Status)

Primarily, in what role will you be using the Recovery College? As a:

Your Chosen Course

Preferred Course 1

Preferred Course 1 Start Date

Preferred Course 2

Preferred Course 2 Start Date

Preferred Course 3

Preferred Course 3 Start Date

Preferred Course 4

Preferred Course 4 Start Date

Preferred Course 5

Preferred Course 5 Start Date

Other course of interest, not listed

Your single preferred location

Other preferred location not yet listed

Supporting Your Learning

We understand that you may have specific conditions (e.g. Dyslexia) that may create additional needs (e.g. coloured overlays).

We encourage you to use the resources/support you already have available, to help you in your learning.

And remember, you're welcome to bring a friend or supporter to help you. They just need to register and enrol on the course you're attending.

To ensure the best learning experience, please answer the following questions:

Is there anything which makes learning more difficult for you, that you wish the College staff to be made aware of? (e.g. Dyslexia, limited literacy skills, severe mental health challenge)

Yes No

More Information

Do you have any physical health conditions (e.g. type 1 Diabetes, Epilepsy) or specific accessibility requirements (e.g. wheel chair user, difficulty with stairs) that may affect your learning or attendance to sessions?

Yes No

More Information

Do you have any communication difficulties (e.g. understanding others) that may impact upon your learning?

Yes No

More Information

Any Additional Learning Needs

Emergency Contact Name and Relationship

Emergency Contact Number

Equality and Diversity Monitoring

Age Group

Ethnicity

Student Declaration

I have provided at least one way that I can be contacted

Yes No

Information sharing statement

Please read

When you register to attend courses with the Lincolnshire Recovery College, part of Lincolnshire Partnership NHS Foundation Trust you have been asked to provide personal information to help us to be able to communicate effectively with you, support your learning as required and deliver the best standards of educational experience that we are able to. Everyone working for the NHS has a legal duty to maintain the highest level of confidentiality about your information.

The information you provide will be kept together and form a student record. Student records are stored on Mind Recovery Net (Mindrecoverynet.org.uk is a customer relationship management (CRM) software crafted to help Mental Health Recovery Colleges and training providers manage their applications, students, courses, tutors, course schedule, venues, bookings, attendance and impact and outcome assessment.) via the Trusts network. Every reasonable precaution will be taken to safeguard the personal information you have entrusted to us.

Sometimes other agencies could be involved, and we may need to share information with them in order to safeguard. Anyone who receives confidential information about you from us is also under a legal duty of confidence. We will not disclose your information outside these agencies without your knowledge unless the health and safety of yourself or others is at risk or if we are required by law under the Data Protection Act 2018.

You have a right to see and comment on any of the information we hold about you. If you do have any concerns or queries about this, then please discuss this with the College. Further information about our legal basis for processing your information is detailed on our Trust website privacy policy and there is an additional leaflet 'How we use and share your information' to help you. If you do not wish to have your records accessed for research purposes, please visit https://digital.nhs.uk/services/national-data-opt-out-programme to set your choices.

I have read and understood the confidentiality and information sharing information