Complete this form to apply for your £50 Cycle Repair and Key Accessories Voucher

By filling in this application form you are giving consent to record your personal information with the Isle of Wight Council (the Data Processor) and our delivery partner, A-To-There Solutions Ltd, which has been appointed by Isle of Wight Council to manage the Access Fund programme.


The information we want to record is your name, your email address, your address and your line manager's email address. This information is required so that we can verify your application and then arrange and send your £50 voucher to you. In addition, the information may be used for evaluation purposes (anonymised) of those which have participated in the Connect2Work Programme.

We will keep your personal data for 6 months. 

For more information on how we collect data please view our Website & Privacy Policy: https://www.connect2work.info/website-privacy-notice

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* 1. Full Name

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* 2. Email Address (We will be using this as our main form of correspondence to contact you)

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* 3. Address (we will use this to send you your voucher)

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* 4. Who is your employer?

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* 5. What is your job title?

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* 6. What is your line manager's name 

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* 7. What is your line manager's email address?

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* 8. This information will be used to contact you about your application, and for a follow-up survey if you consent

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* 9. Any other comments?

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