Please use the boxes below to enter the details of your enquiry, and complete the rest of this form to ensure that you understand our Confidentiality Policy. Completing this form will enable us to handle your query in a manner that best suits you.
In order to use and store your information in an appropriate manner and in line with our Confidentiality Policy, please complete the following details and submit on line. This will allow us to liaise with you about your case. This information will be stored confidentially with your record file. By submitting this form you will be agreeing to us storing and using the information you have provided in the manner described below. If you have any questions about the information we are asking you to provide please do not hesitate to contact us.
Anything you say to a member of the Advice and Representation Centre will be kept confidential within the centre unless it is felt there is a serious risk to you or another person.
Please tick to confirm you understand the statement on confidentiality.
I understand that the SU will use the information on this sheet to help monitor the use of services, and that the Students’ Union complies with the Data Protection Act 1998. I give my permission for any sensitive information about my case to be stored securely.
Please tick to confirm you understand the statement on data protection.
Please complete the following –
Can we contact you by email (marked confidential)?
Yes No N/A
Can we leave messages for you on the phone number provided?
Can we discuss your case with your parents/guardians if they contact the Advice and Representation Centre?
Can we disclose/discuss circumstances with relevant individuals/organisations as appropriate?
(use the box below to exclude individuals/organisations from this permission)
The following individual(s)/organisations(s) is/are excluded from this permission:
Please press 'Submit' ONCE ONLY to submit your query