Sussex Recovery College Registration Form

Brighton and Hove Campus

You can choose up to three courses, All information from the registration form will be kept in compliance with the Data Protection Act 1998.

Please post your completed form to:

Brighton and Hove Recovery College, Southdown Learning & Community Hub 42, Frederick Place , Brighton, East Sussex, BN1 4EA

Are you a returning Student?Yes No 

1. PERSONAL AND CONTACT DETAILS
Full Name
Date of Birth
Current address / Postcode
Telephone / Mobile
Email address
Preferred method of contact / PostTelephoneEmail(please tick)

Contact details in case of emergency
Contact name
Contact telephone
2. COURSE DETAILS (up to three preferred courses)
Campus / Brighton & Hove

Hastings
 / Chichester

West Sussex Coastal
 / Crawley & Horsham

Wealden Eastbourne Lewes

Course Title / Start date
Course 1
Course 2
Course 3
3. STUDENT UNION / REPRESENTATION AND RESEARCH NETWORK
We encourage all Sussex Recovery College students to join the Recovery College Student Union and have a say in the running of the college.
Would you like to be part of the student union? / YES / NO
Would you like to keep up to date with Sussex Partnership Trust’s research activity by joining the Research Network? / YES / NO
4. ABOUT YOU
Sussex Recovery College is for people with mental health challenges, their relatives, friends and carers and the staff of the partner organisations.
Do you use any services or see anyone from Sussex Partnership
(or have you in the past six months)? / YES / NO
Please give details of service and person
(if known)
Do you see anyone or use any other service related to mental health and recovery, e.g. Southdown, Together, Mind, Alzheimer’s Society? / YES / NO
Please give details of service and person
(if known)
Are you a carer, relative or friend of someone who uses mental health and recovery services? / YES / NO
What is the name and date and date of birth of the person you care for? / DOB
Are you a member of staff with SPFT or another partner organisation? / YES / NO
Please specify which organisation
5. DISABILITIES AND LEARNING DIFFICULTIES (tick as many boxes as needed)
This information will be used to make reasonable adjustments to support you and ensure the course is accessible for you
Learning Disabilities / Autism or Asperger’s Syndrome
Learning support needs 3.g. dyslexia, dyspraxia, dyscalculia / Emotional / Behavioural Difficulties
Physical Disabilities / Need practical support
Sensory Impairment / Hearing / Longstanding illness
Sight
Mental health support needs / Dementia
Other (please specify) / Unseen Disability – i.e. Asthma,
Epilepsy, Diabetes
6. ADDITIONAL INFORMATION
Are you an Asylum Seeker or Refugee? / YES / NO / Prefer not to say
What is your first language?
Will you require an interpreter / YES / NO
Signature: / Date:

Equal Opportunities Monitoring Form

We are committed to ensuring that all students are treated equally.

This form is intended to help us maintain equal opportunities best practice. Please complete this form and return it with your application. The form will be separated from your application on receipt. The information on this form will be used for monitoring purposes only. It will not be shared with the tutors. The answers you give are very important to us and will be kept confidential in accordance with the Data Protection Act and only used for data analysis to improve our services.

All questions are optional but the more information you supply, the more effective our monitoring will be. All information will be treated in the strictest confidence.

Age / Sexual Orientation
Lesbian / Heterosexual
Gay / Other
Gender / Bisexual / Prefer not to say
Female
Male / Do you or have you ever considered yourself transgender? / YES / NO / Prefer not to say
Other
Ethnic Origin (tick one box)
White / Mixed / Asian or Asian British / Black or Black British
British/English/ Welsh/Scottish/ Northern Irish / White and Black Caribbean / Indian / Caribbean
Irish / White and Black African / Pakistani / African
Gypsy / White and Asian / Bangladeshi / Sudanese
Irish Traveller / Asian and African / Chinese / Any other Black background
Polish / Any other mixed background / Japanese / Other ethnic Grop
Portuguese / Any other ethnic group / Other Asian background / Arab
Sudanese / Turkish
Any other White background / Prefer not to say / If ticked other, please specify:
Religion
No particular religion / Buddhist / Pagan
Agnostic / Christian / Rastafarian
Atheist / Humanist / Sikh
Baha’i / Jain / Spiritualist
Catholic / Japanese (Shinto) / Other
Chinese (Taoist) / Jewish / Prefer not to say
Hindu / Muslim
Disability
Do you have a disability? / YESNO / Are you registered disabled? / YESNO
Are you a carer? / YES / NO / Prefer not to say
If you are a carer, do you care for a …? / Parent / Partner/Spouse
Child with special needs / Friend
Other family member / Other
Are you: / YES / NO
Currently serving in the UK Armed Forces?
A veteran / ex-serviceman or woman of the UK Armed Forces?
A member of a serviceman or woman’s immediate family?
A reservist or in part-time service (e.g. territorial army)?

Please send completed form to:

Brighton and Hove Recovery College

Southdown Learning & Community Hub

42, Frederick Place,

Brighton

East Sussex

BN1 4EA

If you need help filling in this form, please contact us at the above address or

Telephone: 01273 749500

Email: