Mind the Gap – Booking Form
This initiative was funded by HIV Prevention England to provide training to managers and high level staff. This effective, practical training will provide you with simple practical steps to embed sexual health into your practices, improving your service and wellbeing outcomes for your clients. We have training sessions available in Hertfordshire, Luton and Bedfordshire.
To attend a free training session, please complete this form in full and email to . We will confirm your booking once we receive this form.
Please contact us with any queries about training or our wider work.
Organisations Details:
Name:Address:
Town:
County
Postcode:
Branch/Area:
Specialty/type of clients:
Organisation phone:
Organisation email:
Your details
Name:
Job Role:
Telephone:
Email:
First Choice:
(delete as appropriate)
Registration: 09:10
Start: 09:30
Finish: 12:30 / HERTFORDSHIRE
Wed 28th March - Welwyn Garden City (Folacare Centre for Unity, AL8 6JG)
Fri 20th April – Watford (Holywell Community Centre, WD18 9QD)
Fri 4th May – Stevenage (Stoneyhall Community Center, SG1 3UG)
Wed 23rd May – Hemel Hempstead (South Hill Centre, HP1 1JF)
Mon 11th June – Stanstead Abbots (10 mins from Hertford/ Ware/ Hoddesdon) (Nigel Copping Community Building, SG12 8GA)
Tue 26thJune – Welwyn Garden City (Folacare Centre for Unity, AL8 6JG)
LUTON AND BEDFORDSHIRE
Fri 16th March – Bedford Town Centre (ACCM, 3A Woburn Road. MK40 1EG
Mon 23rd April – Bedford Town Centre (ACCM, 3A Woburn Road. MK40 1EG
Thur 10th May – Dunstable (Incuba, Dunstable, LU6 1AA)
Wed 06th June – Luton Town Centre (Embrace Life Luton, 63 Inkerman Street, LU1 1JD)
Mon 2nd July – Bedford Town Centre (ACCM, 3A Woburn Road. MK40 1EG
Tue 17th July - Dunstable (Incuba, Dunstable, LU6 1AA)
Second Choice:
(delete as appropriate)
Registration: 09:10
Start: 09:30
Finish: 12:30 / HERTFORDSHIRE
Wed 28th March - Welwyn Garden City (Folacare Centre for Unity, AL8 6JG)
Fri 20th April – Watford (Holywell Community Centre, WD18 9QD)
Fri 4th May – Stevenage (Stoneyhall Community Center, SG1 3UG)
Wed 23rd May – Hemel Hempstead (South Hill Centre, HP1 1JF)
Mon 11th June – Stanstead Abbots (10 mins from Hertford/ Ware/ Hoddesdon) (Nigel Copping Community Building, SG12 8GA)
Tue 26thJune – Welwyn Garden City (Folacare Centre for Unity, AL8 6JG)
LUTON AND BEDFORDSHIRE
Fri 16th March – Bedford Town Centre (ACCM, 3A Woburn Road. MK40 1EG
Mon 23rd April – Bedford Town Centre (ACCM, 3A Woburn Road. MK40 1EG
Thur 10th May – Dunstable (Incuba, Dunstable, LU6 1AA)
Wed 06th June – Luton Town Centre (Embrace Life Luton, 63 Inkerman Street, LU1 1JD)
Mon 2nd July – Bedford Town Centre (ACCM, 3A Woburn Road. MK40 1EG
Tue 17th July - Dunstable (Incuba, Dunstable, LU6 1AA)
Additional requirements:
Signature:
Date (form is submitted on):
Sexual Health in your Organisation:
Number of colleagues you could champion sexual health to, and potentially change their working practice:Number of clients who use your organisation:
Number of referrals to sexual health services in the past 3 months
(if you do not collect this information, please indicate)
Number of referrals for an HIV test in the past 3 months
(if you do not collect this information, please indicate)
Number of clients signposted to sexual health or HIV services in the past 3 months
(if you do not collect this information, please indicate)
Does your organisation discuss sexual health with clients?
(Please indicate all that are relevant) / At induction | In assessment | At other times | No
Does your organisation discuss HIV with clients?
(Please indicate all that are relevant) / In induction | In assessment | At other times | No
Does your organisation help clients reduce high risk sexual behaviours? / Yes | Somewhat | No
Does your organisation help clients increase their use of condoms or other sex barriers? / Yes | Somewhat | No
Does your organisation provide access to condoms and/or other sex barriers? / Yes | Somewhat | No
If yes, for any of the last three questions, how does your organisation do this?
What do you hope to gain from this course?