The Blossom Charity Development Award

Firstly, we like to ask where you are now in your life, circumstances, and how you feel, so we can get to know you better. This will enable us to help you in a more personal way, making sure you can get the most out of this experience. We will also ask you to complete a post evaluation form at the end of your course, so we can clearly see the changes you’ve made.

Secondly, the majority of the courses we run are funded by grants. When applying for grants we use this data to help express what we do. When grants are awarded, data is used to help keep the funders up-to-date, and targets are used to show the rate of success. All data we use will be anonymous and we promise not to share your personal information with third parties.

Current employment status

Income band

How do you feel about yourself?

Please answer the following statement giving a scoring out of 10, 1 poor, 5 average, 10 excellent.

Self expression

To what extent do you feel you express your own personality, feelings or ideas, through speech, art or self image?

Self confidence

To what extent do you feel confidence in your ability, judgement and power?

How confident do you feel you can achieve your future goals?

Stress management

How well do you cope with stress and have strategies to manage your stress levels?


I understand who I am and how to be my best self

I have the skills to solve problems

Generally, how fit and well do you feel?


To what extent do you feel you can be assertive?


What level of interaction do you feel you have with others on a weekly basis?

Thinking about where you live how involved do you feel with the local community.

Health and well-being

In order to ensure that you are safe at all times when working with us we need to have some information about your health and wellbeing.

Are you being treated for any medical condition?

In order to comply with the data protection regulation we require you to confirm by ticking the box that you are happy for us to contact you by phone, email or letter. (optional)