Office use only:
Surname:

Devon Recovery Learning Community

New Leaf Farm House Rise Exminster EX6 8AB Phone: 01392 677067 email:

Student Information

Surname / First Name / DOB
Address
Town/City / Postcode
Home phone / Mobile
Email
Who should we contact in the event of an emergency?
Name / Relationship / Phone/mobile

List below the courses on which you would like to enrol(Students can enrol on up to 3 courses during each 3-month term.* If you want to enrol on more than three courses in the current term, you can be added to a waiting list for any further courses running that termand be notified if vacancies become available).

Course name / Page number / Course location / Course dates
1.
2.
3.
W/L
W/L
W/L

Is there anything we need to know that might have an impact on your course attendance or participation?

How would you like us to contact you with course reminders or other updates?

Telephone: Y/N / Mobile: Y/N / Text: Y/N / Email: Y/N

Would you like to be added to our mailing list to receive further information about the DRLC and courses we’ll run in future? Yes / No

If you said YES, how would you like to receive that information? Email / Post (please turn over)

*The Devon Recovery Learning Community is divided into four 3-month terms, with each term indicated by an identifiable icon, such as a blue snowflake for Winter courses and a yellow sun for Summer courses. We produce two course prospectuses a year; an Autumn/Winter prospectus and a Spring/Summer prospectus. Students are able to book onto 3 courses per term on a first come first served basis, but are allowed to be added to a waiting list for any further courses during the current term. Students on waiting lists will be notified as soon as possible if vacancies become available.

Office use only:
Surname: / Calendar: / Booking confirmed/Added to waiting list

To ensure we are offering fair access to our courses please would you be so kind as to answer the following optional questions:

What is your gender?______

(for example: male, female, trans, non-binary, etc.)

What is your ethnicity (i.e. your racial origin)?

White British______Mixed white and black African______

White Irish______Mixed white and Asian______

White other______Any other mixed background______

Caribbean______Indian______

African______Pakistani______

Any other black background____Chinese______

Any other Asian background______

Any other racial group (please specify)______

What is your employment status?

Student______Employed fulltime______Employed on sick leave______

Employed part-time______(ESA) Permitted work______Self-employed______

Registered unemployed______Unwaged- not seeking work______Volunteer______

Permanently sick/disabled______Retired______

Would you be happy for us to contact you 6 months after you have finished the course to ask for your thoughts about the Recovery Learning Community and its courses? Yes/ No

Signed: ______Date:______

Your information:

The Devon Recovery Learning Community is a partnership committed to your recovery. Your information will be held inconfidence and passed on only to Recovery Learning Community staff and partners. It will not be shared with anyexternal organisations without your express permission. The student handbook explains more how we handle yourinformation. If you don’t receive one, please ask for a copy.