Programme Delivery Contract
Please answer the following questions as accurately as possible. This will help the team at Mind of the Student and our delivery partner, Working Options in Education, process your booking request more efficiently. We look forward to visiting your school soon.
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Your School Details
Please provide us with your school name and address. You can find your school address by searching the name of your school in the first address field.
School Name
*
Please enter the school/establishment name.
School Address
*
Street Address
Street Address Line 2
City
County
Postcode
Local Authority
*
Please Select
Adur
Allerdale
Amber Valley
Arun
Ashfield
Ashford
Babergh
Barking and Dagenham
Barnet
Barnsley
Barrow-in-Furness
Basildon
Basingstoke and Deane
Bassetlaw
Bath and North East Somerset
Bedford
Bexley
Birmingham
Blaby
Blackburn with Darwen
Blackpool
Blaenau Gwent
Bolsover
Bolton
Boston
Bournemouth, Christchurch and Poole
Bracknell Forest
Bradford
Braintree
Breckland
Brent
Brentwood
Bridgend
Brighton and Hove
Bristol, City of
Broadland
Bromley
Bromsgrove
Broxbourne
Broxtowe
Buckinghamshire
Burnley
Bury
Caerphilly
Calderdale
Cambridge
Camden
Cannock Chase
Canterbury
Cardiff
Carlisle
Carmarthenshire
Castle Point
Central Bedfordshire
Ceredigion
Charnwood
Chelmsford
Cheltenham
Cherwell
Cheshire East
Cheshire West and Chester
Chesterfield
Chichester
Chorley
City of London
Colchester
Conwy
Copeland
Cornwall
Cotswold
County Durham
Coventry
Craven
Crawley
Croydon
Dacorum
Darlington
Dartford
Denbighshire
Derby
Derbyshire Dales
Doncaster
Dorset
Dover
Dudley
Ealing
East Cambridgeshire
East Devon
East Hampshire
East Hertfordshire
East Lindsey
East Riding of Yorkshire
East Staffordshire
East Suffolk
Eastbourne
Eastleigh
Eden
Elmbridge
Enfield
Epping Forest
Epsom and Ewell
Erewash
Exeter
Fareham
Fenland
Flintshire
Folkestone and Hythe
Forest of Dean
Fylde
Gateshead
Gedling
Gloucester
Gosport
Gravesham
Great Yarmouth
Greenwich
Guildford
Gwynedd
Hackney
Halton
Hambleton
Hammersmith and Fulham
Harborough
Haringey
Harlow
Harrogate
Harrow
Hart
Hartlepool
Hastings
Havant
Havering
Herefordshire, County of
Hertsmere
High Peak
Hillingdon
Hinckley and Bosworth
Horsham
Hounslow
Huntingdonshire
Hyndburn
Ipswich
Isle of Anglesey
Isle of Wight
Isles of Scilly
Islington
Kensington and Chelsea
King's Lynn and West Norfolk
Kingston upon Hull, City of
Kingston upon Thames
Kirklees
Knowsley
Lambeth
Lancaster
Leeds
Leicester
Lewes
Lewisham
Lichfield
Lincoln
Liverpool
Luton
Maidstone
Maldon
Malvern Hills
Manchester
Mansfield
Medway
Melton
Mendip
Merthyr Tydfil
Merton
Mid Devon
Mid Suffolk
Mid Sussex
Middlesbrough
Milton Keynes
Mole Valley
Monmouthshire
Neath Port Talbot
New Forest
Newark and Sherwood
Newcastle upon Tyne
Newcastle-under-Lyme
Newham
Newport
North Devon
North East Derbyshire
North East Lincolnshire
North Hertfordshire
North Kesteven
North Lincolnshire
North Norfolk
North Northamptonshire
North Somerset
North Tyneside
North Warwickshire
North West Leicestershire
Northumberland
Norwich
Nottingham
Nuneaton and Bedworth
Oadby and Wigston
Oldham
Oxford
Pembrokeshire
Pendle
Peterborough
Plymouth
Portsmouth
Powys
Preston
Reading
Redbridge
Redcar and Cleveland
Redditch
Reigate and Banstead
Rhondda Cynon Taf
Ribble Valley
Richmond upon Thames
Richmondshire
Rochdale
Rochford
Rossendale
Rother
Rotherham
Rugby
Runnymede
Rushcliffe
Rushmoor
Rutland
Ryedale
Salford
Sandwell
Scarborough
Sedgemoor
Sefton
Selby
Sevenoaks
Sheffield
Shropshire
Slough
Solihull
Somerset West and Taunton
South Cambridgeshire
South Derbyshire
South Gloucestershire
South Hams
South Holland
South Kesteven
South Lakeland
South Norfolk
South Oxfordshire
South Ribble
South Somerset
South Staffordshire
South Tyneside
Southampton
Southend-on-Sea
Southwark
Spelthorne
St Albans
St. Helens
Stafford
Staffordshire Moorlands
Stevenage
Stockport
Stockton-on-Tees
Stoke-on-Trent
Stratford-on-Avon
Stroud
Sunderland
Surrey Heath
Sutton
Swale
Swansea
Swindon
Tameside
Tamworth
Tandridge
Teignbridge
Telford and Wrekin
Tendring
Test Valley
Tewkesbury
Thanet
Three Rivers
Thurrock
Tonbridge and Malling
Torbay
Torfaen
Torridge
Tower Hamlets
Trafford
Tunbridge Wells
Uttlesford
Vale of Glamorgan
Vale of White Horse
Wakefield
Walsall
Waltham Forest
Wandsworth
Warrington
Warwick
Watford
Waverley
Wealden
Welwyn Hatfield
West Berkshire
West Devon
West Lancashire
West Lindsey
West Northamptonshire
West Oxfordshire
West Suffolk
Westminster
Wigan
Wiltshire
Winchester
Windsor and Maidenhead
Wirral
Woking
Wokingham
Wolverhampton
Worcester
Worthing
Wrexham
Wychavon
Wyre
Wyre Forest
York
Local Authority Validator
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Your Details
Full Name
*
Please provide the point of contact who will be contactable on the training day.
Position
*
Office Number
*
Office Number Validator
Extension
*
If you do not have an extension number, please enter 0.
Mobile Number
*
Mobile Number Validator
Email Address
*
example@example.com
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SLT Contact Details
This contract must be co-signed by a member of your Senior Leadership Team (SLT). If you are already a member of SLT, please put N/A.
SLT Contact Full Name
*
SLT Position
*
Headteacher, Deputy Head, Assistant Head etc.
SLT Email
*
example@example.com
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Availability Calendar
Please confirm this date with your team before proceeding, as we may be unable to change your workshop date once this form is submitted.
Workshop Day Date
*
Workshop Date Validator
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Student Numbers and Year Groups
Please tell us the total number of students taking part. Please ensure you select at least 4 year groups to take part.
Number of Students (Total)
*
Year Groups Taking Part
*
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Year 13
Year Groups Taking Part Validator
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Your Timetable
Please add your timetable for the workshop day, including all breaks (4 sessions min)
*
Timetable Validator
Example Timetable
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General Information
Will your school provide a FREE school lunch for our facilitators?
*
Yes
No
Will your school provide onsite parking for our facilitators?
*
Yes
No
Reasonable Adjustments
*
Adjustments Required
Not Required
Please give further details
Please confirm you have a projector/screen with HDMI input, audio and IT support at hand to support our facilitators throughout the day.
*
Yes
Projector/Screen Validator
Please confirm you will have appropriate levels of staffing provided by the school to monitor and manage student behaviour during workshop delivery.
*
Yes
Staffing Levels Validator
Please confirm you have reserved your hall or a space large enough to accommodate the whole school workshop day.
*
Yes
Hall Available Validator
Equipment Drop-Off/Collection
*
How did you hear about us?
*
Please Select
Word of Mouth
Social Media
Partner School
Referral Programme
Another School
Email Marketing
Working Options
Other
Referrer Full Name
*
If you was referred to Mind of the Student by a colleague, please add their name here.
Are you happy for our Booking Provider (Working Options in Education) to contact you for future FREE school workshops?
*
Yes
No
Would you be interested in fundraising for Mind of the Student, so that another school can receive a FREE mental health workshop day?
*
Yes
No
Fundraising Contact Full Name
Fundraising Contact Email
example@example.com
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Safeguarding
Pastoral Care and Safeguarding Team
*
Pastoral Care and Safeguarding Team Poster (Optional)
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Agreement
Please sign to confirm you agree to our Terms and Conditions set out in the
Delivery Contract
which has been attached here.
*
Date of Submission Validator
-
Day
-
Month
Year
Date
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