Advanced Health and Wellbeing Training Programme – Expression of Interest

Name
Job title
Name of organisation
Postal address of organisation
Email address
Telephone number
How did you find out about this course?
Is your service in receipt of Public Health funding? If yes, please provide name of contract if known.
Does your manager support your application to the programme and attendance to all training dates, and are they aware of the £80 attendance fee?
Please let us know if the attendance fee would present a significant barrier to you attending. We may be able to provide support with this.
Application statement
(Please provide details about why you wish to attend the programme and what you hope to gain from it)
Data Protection
Leeds City Council is the Data Controller for the information you provide. We process personal data relating to participants of training events for the purpose of monitoring the uptake and quality of our performance as well as to assist us with planning, improving and promoting the services we deliver.
The personal data includes identifiers such as name, job title, name and postal address of your organisation, email address and telephone number. We will not share information about you with third parties without your consent unless the law allows or requires us to do so. If you would like to find out more about how we use and store your personal data or want to see a copy of the information that we hold about you, please contact:
Ben Foord, Public Health Capacity and Capability Support
Adults and Health Directorate, Leeds City Council
T: 0113 3786034
E:
Declaration
I consent to my information being stored electronically on the Leeds Public Health Capacity & Capability Team system and processed for the purpose of monitoring the uptake and quality of the performance of Leeds Public Health Training, as well as to assist with planning, improving and promoting the services that are delivered, in accordance with the Data Protection Act 1998 and within the provisions outlined above. I understand I can withdraw my consent at any time.
I provide my consent I do not provide my consent
I consent to details of my job title, the name of my team and organization being shared with third parties including other Leeds City Council departments, voluntary sector organisations and colleagues within the health sector to assist them in determining uptake of the Leeds Public Health Training offer by their staff and to assist them in planning their own training provision.
I provide my consent I do not provide my consent
I consent to receive information about future training opportunities sent to me by the Leeds City Council Public Health Capacity & Capability Team and the Leeds Public Health Resource Centre by (please tick):
Email Post Address Other (please state) ______
Name
Signature
Date
Name of staff member witnessing
Please tick to indicate if only verbal consent given

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