Aware NI - Fundraising Pack

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Contact Us

Learn About Depression
Mental Health Services
Wellbeing Programmes
Fundraising
Mental Health Awards (IMH)
AWARE at 30

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Fundraising
Fundraising Pack

ET 5878 Mindfulness-based Cognitive Therapy for Primary Teachers & Classroom Assistants Mondays 21st September - 16th November

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First Name(*)

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Age Group (*)

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School(*)

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County [Select one from the drop down](*)

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What trust area do you live in?(*)

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Please state below if you have any access requirements: (including help with reading and writing)?

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Is there any other information you feel is relevant to your application?

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Who referred you for this course? (*)

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If someone else referred you, please give their details below

Referee Name

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The aim of these programmes is to promote awareness of your mind and body through the cultivation of mindfulness practice. It is suitable for people who wish to enhance their wellbeing and develop a mindfulness practice. Please let us know if you have any health care needs. We are unable to take responsibility for any aspect of your health care during or after the programme.

What is your motivation or reason for taking this course? Or how do you think it might benefit you?(*)

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Physical Condition

Do you have any limitation on your physical mobility that might make sitting, standing, walking or gentle yoga difficult for you?(*)

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If yes, please describe as fully as possible.

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Are there any present circumstances which might be placing you under additional stress or make meditation difficult for you eg depression, anxiety, psychotic illness, drug and/or alcohol dependency issues, stressful life changes (eg bereavement, loss of home, job etc)?(*)

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If yes, please give details

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State of mind

Please be assured that any information that you share with us either during or outside the sessions, will be confidential. In the unlikely event of serious concerns about your health and safety, these will be discussed with you and, if necessary, with a contact person whom you have nominated.

GDPR Agreement

We really appreciate your ongoing support of our cause. We would love to tell you occasionally about events and campaigns going forward. You can always unsubscribe at any time and can choose how you would like us to contact you. We will never sell your details to another organisation and they will be held securely and confidentially. To read our full privacy notice contact it is available on the website here: Privacy Policy

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I do not wish to be contacted

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I wish to apply for a place on the above course. I consent to the information provided in this form being shared with the course mindfulness trainer. If requested, I agree to provide information, which will assist in the overall evaluation of the programme. I understand that any such information will be provided anonymously, will be treated in the strictest confidence and will not be used for any other purpose.

I understand the confidentiality terms above and I agree to take full responsibility for my health and wellbeing during this 6-week course(*)

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Fundraising

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AWARE is the depression charity for Northern Ireland and the only charity working exclusively for those with depression and bipolar disorder.

Aware Defeat Depression, known as AWARE, Crawford Square, Derry/Londonderry, BT48 7HR, Company No: NI30447. Registered with the Charity Commission for Northern Ireland with charity registration number NIC100561

BELFAST OFFICE

40-44 Duncairn Gardens,
Belfast,
BT15 2GG

Tel: 028 9035 7820

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

DERRY/LONDONDERRY OFFICE

2 Crawford Square
Derry
BT48 7HR

Tel: 028 7126 0602

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