Expression of Interest Form 2.0

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Page 1: RECOLLECT 2 Studies 1 and 2 Student Expression of Interest

Please complete the below information, providing as much detail as possible, for any students who have expressed an interest in taking part in RECOLLECT 2. This will enable a researcher staff member to follow up with the student.

If you are a Recovery College student completing this form for yourself, please note that you will be referred to as 'student'. For example, for the question 'what is the students name?', please put your own name.

This part of the survey uses a table of questions,

1.1. Does the student meet the eligibility criteria? Required

Please don't select more than 1 answer(s) per row.

Please select at least 3 answer(s).

	Yes	No	Unsure
18 years or older?
Currently using or discharged within the last 12 months from the local secondary NHS mental health service
Newly enrolled at a participating Recovery College (i.e. has not yet started a course or has done a maximum of 1 class or workshop)

If the answer to any of the above criteria is no, the student does not meet the eligibility criteria to participate. If the service user meets the inclusion criteria or you are unsure about this, please continue completing the form. A formal check of eligibility will be done by the researcher.

2.2. Please list the name of the Recovery College: Required

3.3. Students full name: Required

4.4. Student's date of birth

5.5. Students telephone number:

Please enter a valid phone number.

6.6. Students e-mail address:

Please enter a valid email address.

7.7. Students address:

8.8. Students preferred method of contact:

9.9. Does the student agree for their details to be shared with the RECOLLECT 2 team/CRN staff member? Required

Yes

10.10. Does the student agree to be contacted by the RECOLLECT 2 team/CRN staff member? Required

Yes

By clicking 'Finish', you are agreeing to be contacted by the RECOLLECT 2 team/CRN staff member. Please close this webpage now if you do not want your information to be shared with RECOLLECT 2 team/CRN staff members.