By entering your name in the box below, you are identifying yourself as the originator of this form and key contact for this young person.
Before entering any personal details for yourself or another person into the following fields you must get explicit written consent to do so.
Consent must make explicit reference to the two following points of information:
1) Information is processed via the secure systems of "surveymonkey.com" (please refer to their website for how they process and store information).
2) Information is processed and held by "eotas swindon" until a student enters Year 12. This is in the form of a secure archive and occurs whether the referral is successful or not.
If you do not have the explicit written permission of an adult with parental responsibility for the young person being referred, do not continue. To do so could make you and your organisation liable for data breach and the associated fines.