Slough Client Online Referrals Online Advice Request for Slough Residents __________________________________________________________________________ If you need advice, complete and submit this form and we will contact you. We’re here to help you but we won’t be able to answer your email straight away. It’s because we’re helping someone like you. Lots of people are struggling at the moment and our staff and volunteers are working really hard to help everyone as quickly and as well as we can. By checking our website you may find the information and help you need and you can often benefit from the option of webchat. Our website can be found here citizensadvice.org.uk When we are open, we aim for one of our Advisers to respond to your email within 5 working days but sometimes it might be longer. We may not be able to action the request on the day and/or time that you have requested. We will contact you as soon as possible. Please note that this service is only available to residents of Slough Borough Council. If you live outside of this area we will not reply to emails. To find your nearest Citizens Advice office, enter your postcode on this webpage: Search for your local Citizens Advice. __________________________________________________________________________ Full Name * Email * Date of Birth * Address * Address House Number / Name House Number / Name Street Name Street Name Town / City Town / City Council Council Post Code Post Code Please describe the enquiry you would like advice or information on. Give as much detail as you can about your situation * Consent to Record and use information When we record and use your personal information we: ● only access it when we have a good reason ● only share what is necessary and relevant ● don’t sell it to commercial organisations We need to record information about you to help with your enquiry. We have a legitimate interest to do this. Please let us know if you’d like more information about how we’ll use your data. Special Category Consent We need your consent to record and use your special category personal data We need your explicit consent to use some information, including your ethnicity, religion, health conditions, sexual orientation, and trade union membership. If you agree, we’ll use this information, which is known as ‘special category personal data’ to: ● give you advice ● help us gather data to improve our service ● support our research in a way that you can’t be identified We’ll make sure all your information is kept safe in our secure case management system. By agreeing to the above, you consent to Citizens Advice recording the special category personal data you choose to provide Citizens Advice. I consent to you recording and using my special category data as follows: * All – ethnicity, religion, health conditions, sexual orientation, and trade union membership Ethnicity Religion Health conditions Sexual orientation Trade union membership I do not consent – this may mean that we are unable to advise you fully Your ethnicity Asian or British Asian – BangladeshiAsian or British Asian – ChineseAsian or British Asian – IndianAsian or British Asian – PakistaniAsian or British Asian – OtherBlack or Black British – AfricaBlack or Black British – CaribbeanBlack or Black British – OtherMixed – White & AsianMixed – White & Black AfricanMixed – White & Black CaribbeanWhite – BritishWhite – EnglishWhite – IrishWhite – Northern IrishWhite – Roma / Gypsy / TravellerWhite – ScottishWhite – WelshWhite – OtherArabOther Your ethnicity Your health – please tick all that apply to you Disabled or have a long term health problem Cognitive impairment Deaf / Hard of hearing Learning difficulty Mental health Multiple impairment Physical impairment (non sensory) Visual impairment OtherOther Your household Single person Single person with dependent children Single person with non-dependent children Couple Couple with dependent children Couple with non-dependent children Other – adults only Other – with dependent children OtherOther Age/s of dependent children under 18 years Your housing Private tenant Council / ALMO Housing association / RSL tenant Buying home (own home with a mortgage) Own home outright (no mortgage) Shared ownership Housed through job or business Staying with relatives or friends – rent free Homeless Hostel Prison Residential accommodation (e.g. Care home) OtherOther Employment status Employed for 30 hours or more a week Employed between 16 hours and 29 hours per week Employed less than 16 hours per week Unemployed – seeking work Volunteer Retired Student On Govt. scheme for employment Carer – elderly / disabled Carer – children Looking after home – no dependents Looking after home – dependents Permanently sick / disabled Self Employed OtherOther Marital status Single Married Cohabiting Civil Partnership (to September 2013) Civil Partnership (post September 2013) Separated but legally married / Civil Partnership Divorced / Civil Partnership Dissolved Widowed / Surviving Civil Partnership Partner OtherOther Nationality British OtherOther First language English OtherOther Feedback We need your permission for feedback We want to make sure our service meets your needs. To help us understand how we’re doing and to improve our service, we may want to contact you at a later date to ask for your feedback. Sometimes we need a trusted research organisation to help us do that. We’ll decide who we contact for feedback based on the services you used and the advice area. We may also use your special category data so that we hear from different groups. For information about how we may collect and store your personal information please click here to view our privacy policy for when you get advice from an adviser Feedback permission * I am happy to be contacted for feedback I do not want to be contacted for feedback Privacy Policy For information about how we may collect and store your personal information and to view our privacy policy for when you get advice from an adviser please go to Privacy & Cookie Policy – Citizens Advice East Berkshire (caeb.org.uk) If you are human, leave this field blank. Submit
