inter-AKT registration form
The Albert Kennedy Trust needs you to complete the following information before you talk to an e-mentor.

AKT is asking for this information because it's important for us to know who is accessing this service. It's also a condition of our funding that we monitor the demographics of young people we work with. This information also helps us learn and improve our services for young people.

All information given will be kept in strictest confidence and in accordance with the Data Protection Act 1998.

The basics
What is your first name? *
Your answer
What is your surname? *
Your answer
What is your date of birth? *
MM
/
DD
/
YYYY
What is your email address? *
Your answer
What is your postcode? *
Your answer
Did a person, service or organisation refer you to inter-AKT? If so, please provide details here, naming the individual and/or organisation:
Your answer
What would you like to talk to us about?
You don't have to complete this section if you'd rather not, or if you're unsure at this stage. It is completely up to you. If you change your mind about what to talk about between now and your mentoring session, that is fine too!
Your answer
How you identify
What is your gender? *
Sexual orientation *
What is your preferred pronoun? *
What is your ethnicity? *
Do you have a disability? If so, please specify here:
Your answer
What is your religious belief? *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms