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Mind and Body Kent: Project Request Form
Please complete this form if you would like to request a programme in your education setting. Following submission, we will be in touch to discuss next steps.
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Email
*
Your email
Date request sent
*
MM
/
DD
/
YYYY
Name of Education Setting
*
Your answer
Type of Education Setting:
*
Secondary School
College
University
Alternative Education Setting
Other
If 'other' is selected, please state what type
Your answer
Contact Name
*
Your answer
Full address, including postcode
*
Your answer
Email address
*
Your answer
Phone number
*
Your answer
Second contact (please make sure this person is aware of your request)
*
Your answer
Age/Year group(s)/Cohort(s)
*
Your answer
Cohort size i.e. number of students in the year group (e.g. Year 9: 200 students)
*
Your answer
Preferred months for the programme
*
Your answer
Please state your reason for requesting this programme
*
Your answer
Please state if this cohort have received any previous interventions
*
Your answer
Any other information you would like us to know
Your answer
Where did you hear about us?
We've had the programme before
Another school
A support agency
Online
Other
Clear selection
If 'other' is selected, please state
Your answer
A copy of your responses will be emailed to the address you provided.
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