MHFA Refresher – June 2025 – Healthmark Grp 1

NAME AND SURNAME:*

I.D. NO:*

DATE OF BIRTH:*

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

Certificate Expiration Date**

*The date shown on your MHFA certificate to indicate expiration of course taken

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.