Contact form – Link Up Youth Hub

Name

First

Last

Preferred name

Please provide your date of birth.

Date

Month

Year

Gender

Gender pronouns

If you have any disabilities you would like to tell us about, please add them below.

Do you have any medical needs?

What support are you looking for from the youth hub?

Phone

Email

Postcode

Preferred method of contact

Call

Text

E-mail

Preferred day(s) to meet the team

Are you currently claiming Universal Credit?

Yes

No

Are you currently employed?

Yes

No

Are you currently in education?

Yes

No

DECLARATION:

Link Up Hub (supported by the Flexible Support Fund) through Department of Work and Pensions may need to share your details with DWP in order to monitor and evaluate the effectiveness of the funding.

Any details you provide may be shared with DWP but will never be published or shared with outside parties. The DWP will comply with the Data Protection Act 1998. These records will last no longer than 2 years. Your name, DOB, national insurance number, gender and post code may be shared.

If you are in receipt of benefits participation of activity through Link Up Hub will not impact your entitlement.

I understand the above declaration and agree to the terms.

I agree

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