Recovery Education Centre - Registration Form

Contact details in case of emergency
Please indicate in which capacity it is that you are accessing the Recovery Education Centre
You can choose more than one option.
If you are accessing a service which is provided by Dorset HealthCare University NHS Foundation Trust, please provide details of your GP, and the Trust Team/Service that you are working with.

Section 2: Courses for which you want to enrol

Please indicate courses below. If you would like to attend more than three courses this term please add details at the end of this form.

Course 1
Add course 2
Course 2
Add course 3
Course 3

Section 3: Additional Support/Assistance

Is English your first language? *
If you indicated that English is not your first language, do you feel that you might need assistance in understanding the course content?

Section 4: Student Declaration

Please indicate whether you have any unspent "relevant" criminal convictions. Relevant unspent criminal convictions against a person (whether violent or sexual), and offences involving drugs or controlled substances. *
Having an unspent relevant criminal conviction does not automatically mean that you will be unable to access a course within the Recovery Education Centre, however the staff team within the Recovery Education Centre will meet to discuss your application.

Equal Opportunities Monitoring

The NHS has an absolute commitment to equality in the services we provide.

The information provided here is only used to monitor and analyse how services are provided.

Please answer all questions.

1. Age *
5. Ethnic Origin
Asian or Asian Background
Black or Black British
Multi-cultural
White
Other ethnic group
8.Disability
Do you consider yourself to have a disability? *
9. Maternity
Are you pregnant at time of completing this form? *

Register

By clicking to register you are confirming that the information you have supplied is correct.

Recovery Education Centre