Knowledge for Change Application Form

Personal details

Name (required)

Address (required)

Postcode (required)

Phone number (required)

Email address (required)

Date of birth (required)

KfC is a 10 week course that requires you to commit to one day a week for ten weeks with an optional accredited level 1 OCN qualification, ‘Developing Healthy Relationships & Respect’ that requires you to complete some coursework outside of the training days. There is support for this if you require it.

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

We teach psychology in a way that helps you make sense of your past experiences and why your life has turned out like it has. What you learn also helps with your life in the present – current relationships and family dynamics for example. As such, KfC c (required)

What personal qualities do you think you will be able to bring to KfC? (required)

We collect information on applicants to Knowledge for Change to help us build a better picture of the kinds of people who come onto our courses. 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.

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)

Was there anything you’d have liked to get out of treatment that you didn’t? (required)

Education & employment history

Do you have any formal qualifications? Eg. 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? Eg. Universal Credit, ESA, 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?Have you had any mental health issues in the last two years? For example – depression, anxiety, psychosis, suicidal thoughts. If yes:

What treatment or support 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

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, rape. 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)

Finally, please tell us how you heard about the course

Thank you for taking the time to fill in this application form. We appreciate that some of the questions may have been difficult.

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

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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