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Identity
Title
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Mr
Miss
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First Name
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Pronouns
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Date Of Birth
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Month
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Year
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Demographic
Gender
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Female
Male
Nonbinary
Female Transgender
Male Transgender
Prefer not to say
Cultural background
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Asian/Asian British
Black/African/Caribbean/Black British
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White
White and Black African
White and Black Caribbean
Address
Address1
Address2
Town
Borough
Post Code
Housing Association
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Ekaya HousingAssociation Ltd
Angell Town RMO Ltd
Barbican Estate Office
Ash Shahada Housing Association
Parkhill Housing
Viridian Housing
Shaftesbury Housing Group
Thorlans Housing Management Society
Camberwell Neighbourhood Office
Guinness Trust
Loughborough Estate Management
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Not Applicable
City
Mental Health Services
Are you currently engaged with a mental health service?
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No
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Have you been previously engaged with mental health services?
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Contact
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Emergency Contact
Title
Full Name
Relationship to Participant
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Email
Content Consent
I give my consent / permission for my artistic content created during Raw Material sessions, to be used if required on Raw Materials social media and website
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Medical/Dietary needs
Do you have any special medical or dietary needs we should know
Media Consent
I give my consent / permission for photos and videos to be taken during the project, to be used if required on Raw Materials social media and website
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Programme
Why you are interested in this project?
Tell us about you as an artist / creative
What do you hope to gain from this course?
How did you hear about Raw Material?
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Media Consent
I give my consent / permission for photos and videos to be taken during the project, to be used if required on Raw Materials social media and website
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Programme
Why you are interested in this project?