Expression of Interest Capture Form

Registration - Your details

Title

First Name

Middle Name

Surname

Contact Telephone Number

Mobile Phone Number

Email Address

Validate Email Address

Date of Birth

/ /

What are your preferred pronouns?

Other (preferred pronouns)

Address

Town/City

Postcode

Preferred method of contact

Email
Home Phone
Mobile
Post

How did you hear about us?

If 'other', please specify

Emergency Contact

Emergency Contact Name

Emergency Contact Number

Emergency Contact Relationship

About You

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

And do you belong to another group as well?

I care for someone with a mental health condition
I support someone with a mental health condition
I have lived experience of mental health
I volunteer/work in Cardiff & Vale Mental Health Services
I currently use Mental Health Services
I work in Cardiff and the Vale
I currently use Physical Health services

Would you like to meet a Peer Trainer? You could use this time to discuss your learning and recovery goals or learning needs such as support with technology, translation or adjustments we can make

Yes No

Do you wish to share any information that may affect your course participation or attendance?

Please select your first language

Do you require support from an interpreter?

Yes No

Equality and Diversity Monitoring

The Cardiff and Vale Recovery and Wellbeing College operates a policy of equal opportunity and fair treatment. We would be grateful if you complete this form, although completion is voluntary.

Cardiff and Vale Recovery and Wellbeing College will aggregate and store the information given on this form, either on computer or as a manual record for a maximum of 12 months.

We will only use it to monitor how our equal opportunities and related monitoring requirements are put in to practice.

We will not use it for any other purpose or reveal it to any organisation except under our statutory obligations.

What is your ethnic group?

Please specify (ethnic group)

Are you a Welsh speaker?

Yes No

What is your sexual orientation?

Please specify (sexual orientation)

What is your Religion or Belief(s)?

Please specify (religion or belief(s))

What is your gender?

Please specify (gender)

Is your gender identity the same as it was at birth?

Age Group

Employment Status

Please specify (employment status)

Recovery College Charter and Code of Conduct

The Recovery College aims to create an environment that encourages learning and where students feel they are supported. This charter is designed to help students to understand what is expected from you and of us, whilst accessing the college.

What you can expect from us:

We will respect you as an individual at all times. We will do this by:

Respecting your values, opinions and beliefs
Equality of opportunity, free of harassment and discrimination
Helping people that support you to access courses e.g. a career, friend or interpreter
Behaving in a way that fosters a shared understanding and mutual respect
Encouragement to take responsibility for your own learning and development
Opportunities for you to comment on and review the courses and facilities on offer
Clear information about the courses on offer
The chance to celebrate success
Suitably trained facilitators and volunteers who are committed to the quality of your experience and to their own professional development

What we expect from you:

Respect the rights, choices, beliefs and opinions of others
Commit to attending course/workshop you have enrolled on
Do my best to inform the college ahead of time, if I am going to be late or miss a session and return from my breaks in a timely manner
Respect the college environment and equipment
Ensure mobile phones are on silent/turned off before entering any learning area
If I act in a way that may put myself or others at risk, I understand I may be asked to leave the course
Avoid the use of language or terminology that might offend others
Do not attend the college if under the influence of alcohol or substances, because if affects my ability to learn and/or ability to conduct myself respectfully.
I agree to behave appropriately within the learning environment and accept guidance from the course facilitator
Keep us informed of any special needs or requirements you have so we can support you in the best way possible
Seek early advice and support whenever you need clarification, or if you have a problem
I will keep any personal/private information heard during any course strictly confidential

By completing this form and enrolling on courses with the Cardiff and Vale Recovery & Wellbeing College, I am confirming that I will abide by the College's code of conduct and agree that I hold responsibility for my own wellbeing when attending a course.. I understand if I disclose information regarding my own safety or the safety of someone else, the Recovery & Wellbeing College will need to take the necessary steps to support in managing the circumstances and if deemed necessary, implement it's safeguarding policy.

Tick to agree to the student charter and code of conduct.