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Blended MHFA Workplace- Agenzija Sapport Registration Form

Group 4 – March 2021

Component 1: eLearning- 8th March – 22nd March

Component 2: Videoconferencing

Session 1- 23rd March from 9am till 11.30am
Session 2- 24th March from 9am till 11.30am

NAME AND SURNAME:*
I.D. NO:*
DATE OF BIRTH:*

Day
Month
Year
PERSONAL ADDRESS:*
Street Address Address Line 2 City ZIP / Postal Code
EMAIL ADDRESS:*
TELEPHONE:
MOBILE:*
GENDER (As per ID card):*
- Male
- Female
RESIDENCE (As per ID card):*
- Malta
- Gozo
EMPLOYMENT STATUS:
- Employed
- Self-Employed
- Unemployed
- Inactive
- Inactive, not in education or training
Employed [Persons should be working on a part-time or full-time, or on reduced hours. Persons in “subsidised” employment should also be considered as employed. Persons currently on maternity leave should also be considered as employed.] ; Unemployed (Persons should be registered with Jobs Plus); Inactive are those persons who are neither in employment nor are they registered unemployed. Full-time students are also considered as inactive; Inactive not in education or training are those persons who are not in employment, registering for work, and/or in education or training.
PROFESSION:*
EDUCATIONAL BACKGROUND:
- Level 4 Diploma
- Level 5 Diploma
- Level 6 Degree
- Level 7 Masters
- Level 8 PhD
Terms and Conditions*
- I have read and accept the terms & conditions including the data handling policy
1. Data given with the registration form will be processed in accordance with the Data Protection Act 2001 and the General Data Protection Act. 2. Certificates will only be given to those participants who attend the 12 hours of training. 3. All materials used in this training course, including the MHFA manual which course participants will receive after the course, are copyright of Richmond Foundation. None of the materials, nor any part of the MHFA manual, may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, without prior, written permission of Richmond Foundation.

NAME AND SURNAME:*
I.D. NO:*
DATE OF BIRTH:*

Day
Month
Year
PERSONAL ADDRESS:*
Street Address Address Line 2 City ZIP / Postal Code
EMAIL ADDRESS:*
TELEPHONE:
MOBILE:*
GENDER (As per ID card):*
- Male
- Female
RESIDENCE (As per ID card):*
- Malta
- Gozo
EMPLOYMENT STATUS:
- Employed
- Self-Employed
- Unemployed
- Inactive
- Inactive, not in education or training
Employed [Persons should be working on a part-time or full-time, or on reduced hours. Persons in “subsidised” employment should also be considered as employed. Persons currently on maternity leave should also be considered as employed.] ; Unemployed (Persons should be registered with Jobs Plus); Inactive are those persons who are neither in employment nor are they registered unemployed. Full-time students are also considered as inactive; Inactive not in education or training are those persons who are not in employment, registering for work, and/or in education or training.
PROFESSION:*
EDUCATIONAL BACKGROUND:
- Level 4 Diploma
- Level 5 Diploma
- Level 6 Degree
- Level 7 Masters
- Level 8 PhD
Terms and Conditions*
- I have read and accept the terms & conditions including the data handling policy
1. Data given with the registration form will be processed in accordance with the Data Protection Act 2001 and the General Data Protection Act. 2. Certificates will only be given to those participants who attend the 12 hours of training. 3. All materials used in this training course, including the MHFA manual which course participants will receive after the course, are copyright of Richmond Foundation. None of the materials, nor any part of the MHFA manual, may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, without prior, written permission of Richmond Foundation.

RICHMOND FOUNDATION

Richmond Foundation is a non-governmental and non-profit making organisation (VO/0017) in terms of the laws of Malta. It is a leading legal NGO in the provision of comminity services for persons with mental health difficulties and in the promotion of mental illness amongst the public.

Richmond Foundation is registered with NCFHE as a Further Education Institution. Licence Number: 2019-011

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424, St Joseph High Road
St Venera, SVR 1013
Malta

+356 2122 4580
+356 2148 2336
+356 2148 0045

Email: mhfa@richmond.org.mt