Men's Development Programme Application Form "Time to Invest in You"

We are delighted that you are applying for the "Time to invest in you" programme. As a first step we need to get to know you a bit better. This helps us to ensure the programme is right for you so that you will get the best out of it. At the end of the course we will also ask you to complete a form which will allow us to identify the changes that you have made.

The majority of the courses we run are funded by grants. Collecting this information is crucial for us as we apply for future funding. When grants are awarded data has to be gathered and used to keep funders informed and to prove that our programmes are being effective. All data that 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)