Application of Interest/Waiting List

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Welcome and thank you for your interest in this 6-week programme.

The course will run for 6 weeks starting Wednesday 3rd June, with sessions taking place at Ditton Community Centre on Wednesdays from 12:30–2:00pm.

Spaces are strictly limited, and priority will be given based on:

Postcode
Parents of school aged children
Availability to attend all sessions

If you are keen to take part, please complete the application of interest below. We will be in touch soon — please keep an eye on your junk/spam folder just in case.

Email *

Please give your full name: *

What is your postcode? *

We will contact you about your place on the programme via email. Please confirm you have checked your email is correct.

Yes, I have checked.

Clear selection

Mobile phone number *

What is your age? *

18-30

31-40

41-50

51-60

60+

How many children do you have under the age of 18 living at home with you? *

None

Do you have any allergies, intolerances or other dietary requirements we need to be aware of? (Food tasters and ingredients will be provided).

Yes

If yes, please provide details below:

What made you interested in this programme?

Improve my health

Lose weight

Learn to cook

Support my family’s health

Feel more confident

Other:

How would you rate your knowledge or skills in the following areas?

I know nothing

I know very little

I know some

I know a fair bit

I know lots

Diet/Nutrition

Cooking/meal making

Fitness/Exercise

Methods for building confidence/self esteem

Wellbeing techniques

Goal setting and how to achieve them

Gut health

Food Science e.g how a carbohydrate is broken down/used in the body

Clear selection

What would help you get the most out of this programme?

What would success look like for you after 6 weeks?

The programme will run for 5 weeks on Wednesdays, 12.30-2pm. Are you able to attend regularly? *

Yes

Maybe

The final session is Saturday 4th July 12.30-2.30pm. This will involve your children. Are you able to attend this final family centred session?

Yes

Maybe

Clear selection

Is there anything that might make it difficult for you to attend?

What barriers do you think prevent you from being able to live a healthy lifestyle? *

Motivation

Discipline

Lack of Education/Knowledge/Skills (about the topic)

Money/Finances

Fear/Anxiety

Confidence/self esteem

Mental health

Time

Support

Other:

Required

Honestly, is there anything else preventing you from achieving your health/wellness goals? Why haven't you achieved them yet?

On a scale of 1 to 5, how much do you believe the following statements about yourself? *

1- I do not believe this at all

3- Neutral

5- I fully believe this

I eat well

I look after my health

I am a positive thinker/person

I have good habits/routines

I set goals and achieve them

On a scale of 1–10, how ready do you feel to make changes to your health? *

Not ready

Extremely ready

On a scale of 1 to 10, how difficult have you found embedding healthy lifestyle habits?
*

Not difficult

Extremely difficult

How did you hear about the Educate Your Plate x Halton Housing programme?

Consent and Next steps *

I agree to be contacted about this programme (tick box)

I understand places are limited and completing this form does not guarantee a place (tick box)

Required

Thanks for completing this application of interest. We will contact you shortly.

You can learn more about us here: https://www.educateyourplate.co.uk/ or follow Educate Your Plate CIC on Instagram @educate_your_plate or on FaceBook

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