OCN course self referral form

July course is now full – waiting list places only.

Please note, this form is for self referrals to our Practical Organic Gardening OCN Course and is for Lewisham residents who are over 18 years old and not currently receiving or in need of support for their mental health.

The contents of this form are treated as confidential by our organisation. Some of the data on this form will be converted to data stored on a computer retrieval system in accordance with the General Data Protection Regulations and Data Protection Action 2018.

Practical Organic Gardening OCN Course - self referrals

For self-referrals to our free Practical Organic Gardening OCN Course. Learners attend every Thursday for 2.5 hours at Sydenham Garden.

A. Eligibility & Personal Details

Please complete all sections below

Are you a resident of the London Borough of Lewisham? We have free places available for Lewisham residents only. (Proof of address may be required at a later date- e.g. recent; council tax bill, utility bill, driving licence, benefits letter, NHS letter).(Required)

Yes, I am currently a Lewisham resident

I am experiencing at least one of the following:(Required)

Learning disability/difficulty

Physical health condition(s)

Isolation

Unemployed and in receipt of benefits

First name(s)(Required)

Surname(Required)

Date of Birth (applicants must be 18 years or older at start of course)(Required)

Address(Required)

PLEASE NOTE THIS COURSE IS ONLY FOR RESIDENTS OF THE LONDON BOROUGH OF LEWISHAM

Postcode(Required)

Main contact number(Required)

This is the preferred contact number - it can be a mobile or landline

Additional contact number

It is very helpful for us to be able to communicate by email, if possible.

B. Wellbeing

If you are experiencing isolation, please can you let us know how this affects you?

If you experience learning difficulties, please can you let us know how this affects you?

If you have any physical health conditions, please can you let us know how this affects you?

If you are unemployed and in receipt of benefits, can you tell us how long you have been unemployed for?

Do you have any access requirements you would like us to be aware of?

(e.g. seated activities required).

D. Risk

Risk to others. Please note: we are only able to accept referrals when risk to others is currently assessed as low. Do you have a history/conviction for violence, aggression or risk to others?(Required)

Yes - within past two years

Yes - over two years ago

If yes, please give further information below.

Details of history of risk to others including dates (e.g. convictions for violence, aggression)(Required)

Risk to self. Do you have a history of self-harm? Please include details of self-neglect, suicide attempts, eating disorders.(Required)

Yes - current

Yes - within past two years

Yes - over two years ago

Further details of risk to self, including dates (current or historic)(Required)

Do you have current or history of drug and alcohol use?(Required)

Yes - current

Yes - historic - currently abstinent

Please note that we ask that people do not attend sessions whilst under the influence of alcohol or illegal drugs.

Are you currently engaged with any drug and alcohol services in the community?(Required)

E. OCN course and support needs

Have you attended a group at Sydenham Garden in the past? Which group(s)?(Required)

Not previously attended

African & Caribbean

Art & Craft

Garden at Wynell Rd

Growing Lives at De Frene Rd

Art Club

Bee Club

Walking Group

Other

Please note that we are not able to consider referrals from people who have already completed two or more project placements with us.

Please note that this course is in 'Practical Organic Gardening', with an emphasis on training participants for further qualifications and work in the industry. Please use this space to share two or three sentences which will tell us why you would like to join the course and what kinds of horticultural roles you might be interested in doing in the future. (e.g. community garden worker, landscape gardener, park maintenance worker, garden designer, food grower).(Required)

Please use this space to tell us about any experience you have which you feel might be relevant to the course. (e.g volunteering at a community garden, helping a friend on their allotment, growing vegetables on your balcony).(Required)

Do you have any barriers to learning or additional support needs that it would be good for us to know about? (e.g. dyslexia, support with writing required, visual learner). How could we best support you to learn if you were offered a placement?(Required)

F: Diversity Monitoring

As part of our monitoring processes we ask for your co-operation in completing the questions in this section. Sydenham Garden is committed to the principles of fairness, consistency, and equality of opportunity. No person will be discriminated against because of their age, disability or ability, ethnicity, gender or gender identity, religion or belief and / or sexual orientation, or if you prefer not to complete this section. The information you enter on this form will be used for monitoring purposes only and all reporting will be anonymous. Data is kept securely in line with current data protection legislation.

Consent(Required)

Yes

Please tick this box to confirm your consent for Sydenham Garden to store and process the information given below to report anonymously on demographic and diversity data for the organisation.

Gender(Required)

Female

Male

Transgender

Non-binary

Other

Prefer not to say

Sexuality(Required)

Heterosexual (straight)

Bisexual

Gay

Lesbian

Asexual

Other

Prefer not to say

Ethnicity(Required)

Religion(Required)

Disabilities & Health Conditions(Required)

Are you registered disabled with the local authority?(Required)

Yes

Not sure

Prefer not to say

Signature(Required)

Date(Required)

Please tick to confirm that you consent to Sydenham Garden processing your personal data(Required)

Yes

Transparency notice to be shown to your client: Sydenham Garden (SG) records certain information about you. This information is overseen by SG’s Data Controller. The Data Controller can be contacted at the Resource Centre Office. We record your name, address and telephone details as well as details of an emergency contact. We also record your mental health diagnosis and important information (such as a risk assessment) sent to us by the health professional who referred you, in order to give you the safest care possible. The legal basis for holding this information is called ‘legitimate interest’. We will hold your records for a further 6 years after you complete your time as a co-worker with us, in line with NHS policy. We will never pass your information onto an external individual or organisation without seeking your consent first. While reports on the effectiveness of the charity’s work are sent to funders including Lewisham CCG and Lewisham Council, it is not possible to identify individuals from these reports. You have the following rights relating to the information that we hold about you: -A right to see the information we hold on you (access). SG will agree to your request as soon as practicably possible and not later than 1 month from the date of the request. -A right to request any errors in your information are corrected (rectification). SG will agree to your request as soon as practicably possible and not later than 1 month from the date of the request. -A right to request your information is erased from Sydenham Garden’s records (erasure). If there is no good reason for SG to hold your information, SG will agree to your request to erase the information it holds on you. However, while you are a co-worker, there will be a continuing good reason to hold the information to help us to provide you with the best care possible. -A right to complain to the Data Controller using the SG Complaints Procedure. If you feel we have not responded correctly to your request please follow the SG Complaints Procedure. Should you not be satisfied after using our complaints procedure you have a right to complain to the Information Commissioners Office via: https://ico.org.uk/concerns/ or by the Helpline on 0303 123 1113.

Thanks for completing this referral. Please click on 'Submit' button below.

Comments

This field is for validation purposes and should be left unchanged.

OCN course self referral form

Practical Organic Gardening OCN Course - self referrals

A. Eligibility & Personal Details

B. Wellbeing

D. Risk

E. OCN course and support needs

F: Diversity Monitoring

Thanks for completing this referral. Please click on 'Submit' button below.

How can you get involved? See below

SUBSCRIBE TO OUR NEWSLETTER

Become a Volunteer

Make A Donation

DONATE

CONTACT US

ABOUT US