We collect this information from everyone we work with to make sure that our services are accessible to everyone in the community. All the information in this form will be kept confidential and in line with our data protection policy. The data will be stored with Mid-Ulster Women's Aid and Women's Aid Federation Northern Ireland. The data collected will be anonymised for evaluation purposes and anonymous findings published. Consent to use your information for evaluation purposes is required in question 1. If you do not wish to share your information please select no.