Thank you for taking the time to complete this survey.

We will be using the information we collect to understand how young people are affected by being housebound and how we can better support them in the future.

The information you provide will be anonymous unless you choose to provide us with your contact details. Your answers will be securely stored and only used over the next 12 months, or until we obtain funding for our proposed work – whichever is sooner.

Full details regarding our Privacy Policy can be found here.

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* 1. Name of Participant (Optional)

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* 2. What is the name of your nearest town?

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* 3. Who is housebound?

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* 4. How many young people aged 16-25 do you know are ‘housebound’ by virtue of their inability/ unwillingness to engage with education, health or social care?

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* 5. What gender are these young people? Please put a number against the relevant category(ies)

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* 6. How many people do you know aged 16-25 that are housebound? Please put a number against the relevant category(ies)

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* 7. Would you mind explaining why you/the people you know struggle to leave the house?

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* 8. Would you be willing to help us to develop our work to pilot a new programme of support? If so please provide an email address. (Optional)

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