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 access a Leicestershire Partnership NHS Trust mental health service, have you accessed one of these services in the past 12 months, or are you on the waiting list for these services?(Required) Yes No Which service do you access or have accessed?(Required)Or, are you a: Carer Relative LPT staff member Your detailsTitle(Required) Mr Mrs Miss Ms Other First name(Required)Preferred nameLast name(Required)PronounsDate 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- English / Welsh / Scottish / Northern Irish / British White- Irish White- Gypsy or Irish Traveller White- Any other White background Mixed- White and Black Carribean Mixed- White and Black African Mixed- White and Asian Mixed- Any other mixed background Asian or Asian British- Indian Asian or Asian British- Pakistani Asian or Asian British- Bangladeshi Asian or Asian British- Chinese Asian or Asian British- any other Asian background Black / African / Caribbean / Black British- African Black / African / Caribbean / Black British- Caribbean Any other Black / African / Caribbean background Other ethnic group- Arab Any other ethnic group Not stated Additional SupportDo you need any extra help during your appointments or our courses?This applies to anyone with a Disability, Learning Difficulty, Physical or Mental Health condition. Yes No Please tell us what extra help you need during your appointments or our courses.Do you have any of the following health conditions? Diabetes Allergies Asthma Epilepsy None of the above Please tell us what extra help you need during your appointments or courses.Additional questionsHow did you hear about the college?Individual Learning Plan AppointmentThank you for filling out this enrolment form. To finish your enrolment and book your courses, we will need to set up an Individual Learning Plan appointment with you. A member of staff from the Recovery College will be in contact with you to book this. How would you prefer to be contacted to arrange the appointment?How would you prefer to be contacted to arrange this appointment? (Please pick one) Email Phone Call Appointment PreferenceAppointment Preference: Please let us know your preferred day and time for your appointment (1 hour slot)
