Register for the Recovery College

Thank you for your interest in joining South West London Recovery College.

We need some information about you for our records; this is in case we need to contact you or the team/service that you receive services from.

*Please contact the Recovery College on 0203 513 5818 if you wish to discuss this further.

Applicant Details

First Name

Surname

Date of birth

Address

Telephone number

Email (this will help us alert you of cancellations etc)

Ethnicity

White Asian/Asian British Black/Black British Mixed White/Asian Mixed White/Black Caribbean Mixed White/Black African

Other (Please state)

Underlying Medical Conditions'

Yes

No

Please indicate whether you have a serious underlying medical condition. To check if you are in this category click here to review the current advice from the government.

Please detail what underlying medical condition/s you have

Course Details

Please indicate whether you are:

Service user Family, friend or carer Staff member

Please indicate which courses you are interested in:

1. Name, date and venue of course

2. Name, date and venue of course

3. Name, date and venue of course

4. Name, date and venue of course

Details of the service that you/the person you care for are under.

Team/service:

GP Name:

Care coordinator/named worker:

Address of service:

Care coordinator/ named worker contact details (email and telephone):

If not currently with a team, what date were you discharged from our services?

Do you have any disabilities or special needs?

Terms & Conditions

I agree to the terms and conditions of the SW London Recovery College Student Charter (https://www.swlstg.nhs.uk/images/Student_Charter.pdf). Under the Data Protection Act 2018, we need your explicit consent to allow us to record and process your personal information. If you agree that we may do this, please tick the box below.