Relates to required fields

Expression of Interest - Your details

Title

Select.... Mr Mrs Miss Ms Dr Prof Rev

First Name

Middle Names

Surname

Date of Birth

dd 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / mm 01 02 03 04 05 06 07 08 09 10 11 12 / yyyy 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Address

Town/City

Postcode

Email Address

Contact Telephone Number

Mobile Phone Number

Preferred method of contact

• Email
• Phone
• Text/SMS
• Post

Preferred time of contact

• Mornings
• Afternoons
• Evenings
• Anytime

About You

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

SelectService UserCarerRelative/FriendProfessional / Staff

And do you belong to another group as well?

• Service User
• Carer
• Relative/Friend
• Professional / Staff

Do you currently access mental health services?

Yes No

Which Partner services do you currently access?

SelectRestoreMINDResponseElmore Community ServicesConnection Floating SupportOxford Health

Ethnicity

Select.... White British White Irish White Scottish White Irish Traveller White other Black African Black Caribbean Black other Asian Indian Asian Pakistani Asian Bangladeshi Asian Chinese Asian other Mixed White & Black Caribbean Mixed White & Black African Mixed White & Asian Mixed other Any other ethnic group I do not wish an ethnic background to be recorded

How did you hear about us?

SelectCarerConnectionConnection FSCPNElder StubbsElmoreElms CentreEmail from the trustEmployment CoachFlyerFriendFrom Oxfordshire MindGP / MINDHospital chaplinInternallyKey Nurse - ProspectusKey WorkerLaunch dayLittlemore recovery groupManzil Way RestoreMindMind and RestoreNewspaperNHSNHS ProfessionOFAFEOMHPOMHP staffOtherOx HealthPartnershipPeer tutor job advertResponseRestoreRestore CoachRestore FacebookRestore Op ProjectRestore Recovery GroupRestore StaffRethinkRethink / Family & FriendsStudent placementTalking Shop Community OrgThrough Restore and MindThrough Restore CoachingThrough WorkWard NurseWarneford Day HospitalWebsiteWord of MouthWorkWork (Restore)

Please select the courses of interest to you

• Recovery College Induction
• Introduction to Recovery
• Understanding Mental Health
• Introduction to the Caring Role
• Tutor Training
• Employment: Exploring Confidence
• Informing Choices: Anti-Depressants
• Introduction to Spirituality in Recovery
• Understanding Psychosis
• Understanding Depression
• Wildlife and Wellbeing
• Introduction to Mindfulness
• Recovery through Exercise
• Understanding Self-harm
• Benefits of Pets
• Mental Health and Wellbeing: Support for Parents
• Navigating the System
• Tai Chi and Wellbeing
• Food and Wellbeing: An Introduction
• Understanding Stigma

Other course of interest, not listed

Your single preferred location

SelectAbingdonBanburyBicesterCholseyDidcotFaringdonOxfordWallingfordWitney

Please select other locations that are suitable

• Abingdon
• Banbury
• Bicester
• Cholsey
• Didcot
• Faringdon
• Oxford
• Wallingford
• Witney

Other preferred location not yet listed

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