RiteTrax x National Lottery Covid-19 Response Music Provision Signup
This form is for ALL participants/beneficiaries, support staff, volunteers, facilitators and others working on the National Lottery funded RiteTrax/Plot 22 response to covid-19, specifically the music-related activities including but not limited to music production, instrument tuition, DJing, music making and lyric writing.
This information is for RiteTrax and will only be shared with potential funders as evidence of our social impact.
The fund is for RiteTrax to deliver targeted music activities to vulnerable adults, specifically those in recovery from drug or alcohol addiction and trauma, ex-offenders, ex-prisoners as well as others at risk of offending or struggling with mental health problems or other complex issues.
The project aims to provide regular weekly creative provision until March 31st 2021 and will document outcomes through visuals including photography and video, as well as through recording of mixtapes, original music and performances. We aim to broadcast as many people as possible through our livestreams, record label and radio shows.
We are currently seeking funding to continue our provision beyond March 31st and are hopeful about the future of the project. Your involvement and support will help us to keep doing this work!
* Required
First name
*
Your answer
Surname
*
Your answer
Email address
*
Your answer
Phone number
*
Your answer
Age
*
18-30
31-39
40-49
50-64
65+
Do any of the following apply?
*
In recovery (from drug or alcohol misuse)
In recovery (from trauma or other)
Ex-offender
Ex-prisoner
Currently on probation
At risk of offending
Care leaver
None of the above
Other:
Required
What gender do you identify with?
*
Female
Male
Non-binary
Prefer not to say
Other:
What sexual orientation do you identify with?
*
Heterosexual / 'Straight'
Homosexual / 'Gay'
Bisexual
Asexual
Prefer not to say
Other:
What ethnic group do you identify with?
*
White
Mixed/Multiple
Asian
Black
Prefer not to say
Other:
Required
Please specify your ethnicity in more detail below (for example 'Black British' or 'Mixed British and Indian' )
Your answer
Do you struggle with any of the following?
*
Mental health
Drugs/Alcohol misuse
Loneliness/Social isolation
None of the above
Other:
Required
Are you currently in work or training?
*
Part time employment
Full time employment
Part time training
Full time training
Self employed
Unemployed
Other:
Required
What are your main areas of interest in this project?
*
DJing
Music making
MCing
Singing
Lyric writing
Radio show / Podcasting
Social aspects
Wellbeing aspects
Other:
Required
What days / times are best for you to come in? (please tick all that apply)
*
Monday AM
Monday PM
Tuesday AM
Tuesday PM
Wednesday AM
Wednesday PM
Thursday AM
Thursday PM
Friday AM
Friday PM
Evenings only
Weekends only
Required
What is your current involvement in the project?
*
Participant / Beneficiary
Volunteer
Support staff
Facilitator
Manager
None of the above
Required
What would you like your future involvement in the project to be?
*
Participant / Beneficary
Volunteer
Support staff
Facilitator
Manager
Other:
Required
Are you registered with support services for any of the following?
*
Drugs/ Alcohol misuse
Housing
DWP - Benefits
Mental health
None of the above
Other:
Required
How did you come into contact with RiteTrax?
*
Personal meeting / direct contact
Through a previous project (Addaction, Ben's centre or other)
Support worker referral
Other:
What are your individual aspirations?
*
Live performance
Recording a DJ mix
Making some original music
Broadcasting on radio or online
Releasing some music
Other:
Required
Is there anything else you'd like support with that's not been mentioned here?
Your answer
Do you give us permission to hold onto these answers (and share them only with potential funders as evidence of our social impact)?
*
Yes
No
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