Thank you for your interest in enrolling with the Leicestershire Recovery College. Once you have completed the enrolment form, we will contact you to arrange an Individual Learning Plan and book you onto the course(s) you are interested in.Enrolment criteriaDo you currently access Leicestershire Partnership NHS Trust mental health services?(Required) Yes No If no, please answer the question belowPlease state which service you currently access(Required) Or, are you a: Carer Relative LPT staff member Your detailsTitle(Required) Mr Mrs Miss Ms Other First name(Required) Last name(Required) Date of birth (please note that our courses are available to students aged 18+)(Required) DD slash MM slash YYYY Email address(Required) Telephone number(Required) Home address(Required) Postcode(Required) Emergency contact details (name, relationship to you, contact number) EthnicityPlease select an option below:(Required) White - British White - Irish Any other White background Mixed - White and Black Carribean Mixed - White and Black African Mixed - White and Asian Any other mixed background Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or Asian British - any other Asian background Black or Black British - Carribean Black or Black British - African Any other Black background Chinese Any other ethnic group Not stated CoursesCourse topics you are interested in?From our range of course topics here at the Leicestershire Recovery College. What course topics are you interested in / want to find out more about? Getting Involved Understanding / The Experience of Mental Health Conditions Building Your Life Developing Skills and Knowledge Physical Health and Wellbeing Select AllAdditional SupportDo you require any support for your learning?This could be related to a disability, learning difficulty, physical health problem or mental health difficulty that may affect your learning or participation on a course. Yes No Please outline any additional information and support you may require to be able to attend a course online or face to face.Do you suffer from any of the following health conditions? Diabetes Allergies Asthma Epilepsy None of the above Please give us additional information and outline any additional support you may require to be able to attend a course online or face to face relating to your health condition(s).Additional questionsHow did you hear about the college? MarketingFrom time to time we will contact you with information about future courses and what’s happening at the Recovery College. Please tick this box if would you like to receive this information sent to the email address provided to us. If you change your mind and no longer wish to receive information from the Recovery College, please contact: 0116 295 1196 or LPT.RecoveryCollege@nhs.net Yes Individual Learning Plan AppointmentThank you for adding your details to this form. To complete your enrolment and book on to courses, you will need to have an Individual Learning Plan appointment. A member of staff from the Recovery College will be in contact with you to book this.How would you like to be contacted to book in your Individual Learning Plan Appointment? (Please pick one) Email Phone Call Appointment PreferencePlease state the day and time you would prefer for your appointment (1 hour slot)
