Inspiring Change Online Enrolment Form

Please tick which Inspiring Change workshops you’re interested in: *

Walking football

Employability skills

Women’s Group

Personal Development Skills

Right At Home

Skills for Work

Skills for Supporting Others (Level 1)

All Being Well

Title: *

Please Select

First name: *

Surname: *

Date of birth: *

Day

Month

Year

National Insurance Number: *

Address line 1: *

Address line 2:

Town/City: *

Postcode: *

Phone: *

Email: *

Ethnicity: *

Please Select

Gender: *

Pronouns:

Are you a UK citizen? *

Yes

No

If you have selected ‘No’ for this question you will need to provide evidence of your residency(e.g. passport, biometric residency card, share code) at enrolment.

Have you been a permanent resident in the UK for the last 3 years? *

Yes

No

If you have selected ‘No’ for this question you will need to provide evidence of your residency(e.g. passport, biometric residency card, share code) at enrolment.

Are you a BCHA Tenant? *

Yes

No

Are you in BCHA Support Housing? *

Yes

No

Emergency Name: *

Emergency Number: *

Emergency Relationship: *

Are you currently working? *

Yes

No

Are you currently in receipt of Universal Credit? *

Yes

No

Are you currently in education? *

Yes

No

Are you currently receiving any training? *

Yes

No

Referrer name:

Referral service name:

Referral service address:

Referrer phone:

Referrer email:

Is there anything (Disability, Health Issues, Addiction, Unspent Convictions, Probation, Licences, Court orders etc.) that you may need support with or may restrict your engagement or concerns that the BCHA Learn Team should be aware of? Please specify*

If this doesn’t apply to you, please put N/A

Facebook

Instagram

Twitter

YouTube

Tik Tok

None

Which social media from the above list do you use the most? *

Have you seen BCHA Learn promotional posts on any of these social media? Please tick all that apply: *

Facebook

Instagram

Twitter

YouTube

None

How did you find out about us? *

Please Select

Please explain in detail: *

What is your preferred method of contact? *

Please Select

Please use this box to provide any further information that would help us to support you/the person referred:

Please ensure this form is fully completed and signed, as we may be unable to proceed without the information. Once received, we will contact you to arrange enrolment. *

By signing this document, I agree with BCHA’s Privacy Notice and give consent for BCHA to share any of the above information with third parties if a risk is disclosed and that we may give details to the referrer regarding your attendance at the course/s referred for. If a referral partner has completed this form, then consent must be agreed prior to the form being shared with BCHA Learn. *

Inspiring Change Exeter Enrolment Form

Client Details

Emergency Contact

Employment

Referral Service Details (if applicable)

Important Client Information

Social Media

How did you find out about us?

Contact

Our Partners