The Visionaries Application Form
It's great you're interested in The Visionaries Programme. To take part in the programme we invite you to complete this application form as it will help us to get to know you and find out a bit about why you want to take part in the programme. All the information filled out will remain completely private and confidential.

Please complete all questions on this form fully and honestly. If you want help filling in this form just ask your teacher or email us at hello@thevisionaries.org.uk

If you wish to advise our staff of any confidential issues which may affect you during your course, please include this information below.

We will follow up with you with a phone call to go over any questions your may.

Many thanks for your interest!
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Name *
School *
Your email address *
Your Mobile Number *
Name and telephone your one of your parents *
Year group *
Date Of Birth *
MM
/
DD
/
YYYY
Female / Male *
What are you passionate about? How do you choose to spend your time outside of school? *
What would you like to be learning about life that you are not being taught in school? *
What skills do want to develop before leaving school that will help you step out into the world feeling confident you can achieve your dreams? *
What does your wellbeing mean to you? Do you feel it is important? If so why? *
What is your relationship to nature and the planet? *
Who do you look to when you need some support in life? Do you have a trusted adult who helps to guide and mentor you? *
How confident do you feel working with strong emotions? *
How comfortable do you feel about the following: *
1 = Not at all comfortable, 5 = Very comfortable
1 Not comfortable at all
2
3
4
5 Very comfortable
Talking about your feelings
Talking about your feelings in a group
Being without your phone for a long period of time
Meeting new people and making new connections
Trying new things and being out of your comfort zone
Working as part of a team
What would you like to get from taking part in The Visionaries programme? *
What might you be able to bring to the group to help make the programme a success? *
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