Recovery College Enrolment Form

Recovery College Enrolment Form
Thank you for your interest in the Recovery College. If you have any difficulties completing this form, please contact the Recovery College at 1300 793 011 or email us at recoverycollege@ths.tas.gov.au
Applicant Details
Title*
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Country of Birth*
Gender*
Preferred Pronoun
Postal Address*
Suburb, Locality or Town*
State*
Post Code*
Phone number*
Please enter a valid phone number.
Email*
example@example.com
Preferred contact method*
What course/s are you interested in?*
What course/s are you interested in?*
Emergency Contact Details
Emergency contact name

First NameLast Name
Emergency contact phone
Please enter a valid phone number.
Personal Details
Do you speak a language other than English at home? (If more than one language is spoken at home, indicate the one that is spoken most often)*

NoYes (please specify)
Would you like to have an interpreter?*

NoYes (Specify Preferred Language)
Are you of Aboriginal or Torres Strait Islander origin?

NoYes, AboriginalYes, Torres Strait IslanderYes, Aboriginal and Torres Strait IslanderPrefer not to say
Do you have any support needs you would like to make the Recovery College aware of?
Do you have a Learning Access Plan you would like to share with the Recovery College?*
What is your highest COMPLETED education level?*
Highest completed education level*
i.e. TAFE or equivalent/Trade
Are you still enrolled in secondary school?*
Of the following categories, which best describes your main reason for undertaking this course?*
Please describe your reason for undertaking this course*
In what role are you interested in undertaking a course with the Recovery College?*

ConsumerFamily memberFriendCommunity MemberStudentPeer WorkerMental Health WorkerVolunteerOther
How did you hear about the Recovery College?*

Word of MouthOnline/social mediaRecommended by another studentRecommended by a clinician/workerAdvertising (Please provide detail)
Privacy and consent*

I consent to my information being collected to ensure the Recovery College educators can meet my learning needs
Personal information will be used only for the purposes described in the Information Collected section above. Your personal information will only be disclosed to organisations or individuals operating outside the Department’s integrated services with your consent, or if it is required by or authorised by law.

Your personal de-identified information (including information contained on this form) may be used or disclosed for statistical, administrative, regulatory and research purposes.

The Recovery College complies with privacy legislation when collecting and storing personal and health information. The Recovery College works in accordance with the Personal Information Protection Act 2004.

For more information on the collection of personal information visit our website Personal information protection statement | Tasmanian Department of Health
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Recovery College Enrolment Form

Applicant Details

Emergency Contact Details

Personal Details