Wellbeing Course Declaration

Full Name

First NameLast Name

Date of Birth

DDMMYYYY

Phone Number

E-mail

What do you want to learn?

Other

Do you have any Mental Wellbeing Issues?

These courses are specifically designed for learners with Mental Wellbeing conditions.

Please choose a different course at www.suttoncollege.ac.uk

Which of of the following Mental Health conditions best describes your current situation?

On a scale of 1 - 10 where are you now with your disclosed issue or condition?

	1	2	3	4	5	6	7	8	9	10

1 is Extremly Poor, 10 is Excellent

On a scale of 1 - 10 where would like you like be at the end of your course with your disclosed issue or condition?

	1	2	3	4	5	6	7	8	9	10

1 is Extremly Poor, 10 is Excellent

What is your personal Wellbeing Target?

(E.g. To attend every lesson. To reduce my anxiety.)

Attendance and punctuality

All learners should be aiming for 100% attendance and punctuality rate.

Are you able to attend all sessions of this course and attend on time?

Please let us know the reasons you will not be in class, or why you may be late at times

Wellbeing classes are Government Funded and a short survey will need to be completed at the end of the course.