Please note - This programme is not suitable for you at this time if you are currently affected by severe depression or if you have experienced a recent major life event, e.g. bereavement, trauma, relationship breakdown etc which might affect your ability to participate fully. If in doubt about your suitability, please contact firstname.lastname@example.org to discuss.
*Fields marked with asterisks are required*
1. Which of the following best describes you? (*)
Please read the following and choose YES or NO
I would like to feel happier and better equipped to deal with life's problems (*)
I want to make some changes in my life and I am prepared to try new things (*)
I plan to attend all sessions (*)
I have basic reading skills (*)
I am happy to attend a group-based programme and participate in discussions with the facilitators and other group members (*)
Please only complete the rest of the form if you have answered
YES to the above questions
Age Group (*)
18-24 25-34 35-44 45-54 55-64 65-74 75+
Please state below if you have any access requirements: (including help with reading and writing)?
Is there any other information you feel is relevant to your application?
Who referred you for this course? (*)
Self Family GP AWARE CPN Mental Health Professional Health Professional
If someone else referred you, please give their details below
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I wish to apply for a place on the above course. If requested, I agree to provide information, which will assist in the overall evaluation of the programme. I understand that any such information will be provided anonymously, will be treated in the strictest confidence and will not be used for any other purpose.
Please tick the box to signify that you agree (*)