Feminism for Change Online Application Form

Personal Details

Name (required)

Address (required)

Postcode (required)

Phone number (required)

Email (required)

Date of birth (required)

FemfC is a 5 week online course that requires you to commit to two half days a week for five weeks.

Is there anything that may get in the way of you completing FemfC Online? (required)

We use feminist theory so that women can make sense of their past experiences and the things that have happened to them by understanding how gender inequality has impacted their lives. What you learn is intended to help you to think about your life in the present – your relationship with yourself and relationships with other important people in your life and family relationships. As such, FemfC Online will sometimes be challenging and emotionally demanding.

How do you feel about the challenge of FemfC Online? (required)

What personal qualities do you think you will be able to bring to the online FemfC group? (required)

We collect information on applicants to Feminism for Change to help us build a better picture of the kinds of people who come onto our course. This is then used to help us apply for funding as some funders will seek to fund people from a specific background – people who have experienced homelessness or have been long-term unemployed for example. All data we collect is anonymous when used for this purpose.

Please take a few minutes to complete the sections below. We appreciate you taking the time to provide us with such personal information. If you need any help with this form please contact us and we can support you with this.

Your experiences of drugs/alcohol

What substances have you used problematically? (required)

At what age did you start using drugs and/or alcohol problematically? (required)

How long did you have a problem with drugs/alcohol for? (required)

If you are currently abstinent, please state how long you have been abstinent for? (required)

Your experiences of substance misuse treatment

How many times have you been in treatment? (required)

How did your experience of treatment help you? Or not? Please give a bit of detail below. (required)

If you have a key worker (or Care Coordinator for your mental health), please list their name, job role and contact details including email and phone number. (required)

Education & employment history

Do you have any formal qualifications? e.g. GCSEs, A-Levels, degree, etc. (required)

If you left school early, what age did you leave? (required)

If you are currently unemployed, how long have you been unemployed for? (required)

If you are receiving benefits, please state what type you are on? e.g. Universal Credit, ESA, JSA etc. (required)

Do you have any learning support needs such as dyslexia, numeracy, literacy? (required)

Mental health

Have you had any mental health issues in the last two years? For example – depression, anxiety, psychosis, suicidal thoughts. If yes: What are/were the mental health issues? (required)

What treatment have you or are you receiving for your mental health issues? (required)

Are you taking prescription medication? If yes, please specify what type, amount and how long you have been on the medication. (required)

Your home life

Do you care for any children? If yes, please list their ages. (required)

Are you a lone parent? (required)

Criminal background

Do you have a criminal record? If yes, please list your offences (type and year charged). (required)

If you were sentenced to prison for any offences, please state how many times you were in prison. (required)

Have you ever committed any violent crime? For example – assault, armed robbery. If yes, please state the offence(s) and year in which you were charged. (required)

Homelessness

Have you ever been homeless? (required)

If yes, please let us know how long you were homeless for. (required)

Domestic abuse

Have you ever accessed services for domestic abuse? An example might be a refuge or calling a helpline. Please say ‘yes’ or ‘no’ below. (required)

Your privacy

The information you enter into this form will be collected and stored by Foundation for Change. Tick the tick box below to confirm that you understand. (required)

I understand

Finally, please tell us how you heard about the course

We will always store your personal details securely, we’ll use them to provide the service you requested, and communicate with you in the way(s) that you have agreed to. Your data may also be used for purposes of analysis, to help us provide the best service possible. For full details, see our Privacy Policy: https://www.foundationforchange.org.uk/privacy-policy

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