ELM Questionnaire

Every Learner Matters - 20/21

The following questionnaire has been designed to help us get to know you and give you the best support possible, while you attend Carlisle College. The information that you provide is confidential and will only be seen by relevant College staff and used to support you and help you achieve on your course.

If you need any help completing this questionnaire then please see your progress coach.
There are 7 sections to this questionnaire containing 36 questions in all.

First Name

Surname

Date of Birth

Select a course

Select your Sex

Do you have a Disability (Not learning difficulty)

Are you in care or a care leaver

Have you ever received exam concessions?

Gain Economic Well Being

Part time job
N/A
Part Time Job - 0-4 Hrs
Part Time Job - 4-8 Hrs
Part Time Job - 8-12 Hrs
Part Time Job - 12-16 Hrs
Part Time Job - 18+ Hrs
Parents / Carers employment
N/A
Both parents/carers are in regular employment
One parent/carer is in regular employment
Both parents/carers are in occasional employment
One parent/carer is in occasional employment
None of the adults that I live with are in employment
Do you live in Scotland and are entitled to EMA
No
Yes
Unsure
N/A
Do you live more than 3 miles from College
No
Yes
N/A
Living circumstances
N/A
I live with my parent(s) / carer(s)
I live with my partner | on my own
I am homeless
Post college life
I don't want careers advice
I want careers advice
N/A
Gambling (Including Bingo, Scratchcards, Lottery, Bandits, Dogs, Horses)
N/A
I sometimes gamble
I regularly gamble
Online gaming
N/A
I never take part in gaming/online
I sometimes play on the computer/online
I spend 2 hours a night on the computer/online
I spend more than 4 hours a night gaming/online
Gaming may have an impact on my college work

Enjoy and Achieve

Time Keeping
N/A
I am always on time
I am sometimes late
I am always late
English skills
English is my 1st language
English is my 2nd language
N/A
Attendance
N/A
I always attended classes at school / college
I sometimes attended classes at school / college
I was home schooled
I did not attend school / college
Support in getting qualifications (Help from Teaching Assistant / Learning Support)
N/A
I achieved my last qualification with no support
I had some support and achieved my last qualification
I had support in most subjects and found it helped
I had a lot of support to achieve my last qualification

Stay Safe

Children
N/A
I am about to become a mum or dad
I have a child / children and do not need support
I have a child / children and I do need support
Parent carer health
N/A
My main parent/carer is healthy
My main parent / carer has a health problem
Young Carer (Responsibilities of care for parent, Grand Parent or siblings). Not own children
N/A
I do not have to care for anyone that I live with
I am the main carer for someone that I live with
Affected by bullying
N/A
I have never been bullied
I have been bullied but don't need support
I have been bullied and need support
Health
N/A
I have no health issues
I have health issues which will not affect my attendance on the course
I have health issues which may affect my attendance of the course

Be Healthy

Mental health
N/A
I feel I have Mental Health / Depression issues and would like support
I have Mental Health / Depression issues which I am receiving help for
I have suffered from Mental Health / Depression issues and do not need support
Managing anger
N/A
I have anger issues which I can manage myself
I have anger issues and need support
Learning difficulty
N/A
I do not have a learning difficulty
I do not think I have a learning difficulty
I received support for a learning difficulty in one of my previous schools
I think I might have a learning difficulty
I have been diagnosed with a learning difficulty

Contact

Are you known to any of these services?
N/A
Police
Social Worker | Childrens Services
Probation service
Young Offenders Service
Adult Social Care
More than 1 of the above
I have been convicted of a crime.
N/A
Yes
No

Health and Wellbeing

Sleep: I struggle with sleep and need to talk to someone
No
Yes
N/A
Alcohol: Which of the following best applies to you?
I have never drank alcohol
I drink only when I go out socialising
I drink most days even when I am not socialising
I have an issue with alcohol and would like to speak to someone for help and advice
I support someone who has an issue with alcohol
N/A
Drugs: Which of the following statements best applies to you?
I have never taken illegal / recreational drugs
I have taken illegal / recreational drugs occasionally
I take illegal / recreational drugs regularly
I take illegal / recreational drugs and would like help
I support someone who has an issue with drugs
N/A
Smoking: Which of the following statements best applies to you?
I have never smoked
I smoke
N/A
I smoke and would like help to quit
Sexual Health: Which of the following statements best applies to you?
I am not sexually active
I am sexually active and do not need to speak to someone
I am sexually active and would like to speak to someone
I am concerned about STIs and would like to speak to someone
N/A
Contraception: I would like to speak to someone regarding contraception
No
Yes
N/A
Pregnancy: Which of the following statements best applies to you?
N/A
I am pregnant
I think I might be pregnant and need a pregnancy test
Self Harm: (cutting, burning, suicide, eating disorders, hitting objects and excessive use of alcohol, drugs and medication) Which of the following statements best applies to you?
I have never self-harmed
I self-harmed in the past and do not need to speak to anyone about it
I have an issue with self-harm
N/A
Bereavement Loss: Which of the following statements best applies to you?
N/A
I have recently lost someone close to me and need to speak to someone
I have recently lost someone close to me but I do not need to speak to anyone about it
Domestic Abuse: Which of the following statements best applies to you?
I have never been involved in domestic abuse
I abuse my partner / someone else
I am abused by my partner / someone else
I am aware of another student in college who is abused by their partner / someone else
I am aware of another student in college who abuses their partner / someone else
I would like to speak to someone for help/advice about abuse I have witnessed
I have been abused in the past
N/A
Sexuality: Which of the following statements best applies to you?
Gay : Refers to a man who has an emotional, romantic and/or sexual orientation towards men.
Lesbian : Refers to a woman who has emotional, romantic and/or sexual orientation towards women.
Hetrosexual (Straight)
Bisexual : Refers to a person who has an emotional, romantic and/or sexual orientation towards more than one gender.
Asexual : Without sexual feelings, desires or associations
Unsure
Pansexual : Not limited in sexual choice with regard to biological sex, gender, or gender identity.
N/A
I would like to speak to someone in Student Services regarding any other issues
No
Yes

COVID-19

Has Covid 19 had a negative impact on your mental wellbeing
Yes
No
Have you or a member of your household been directly effected by the impacts of Covid 19
Financially
Physically
Psychologically
Bereaved
Other
More than one of the above
Not affected