Registration for individuals...
We're so excited that you want to make a positive difference in your community! We need to gather some information about you to ensure our programme is accessible to everyone. If you'd like to know more about why or how we use this data, please contact info@junctionpoint.co.uk 
Our fully funded support package can help you to move from idea, to pilot to launch within 12 months so lets get cracking...
Sign in to Google to save your progress. Learn more
Email *
What is your name?
What is your address?
What is your phone number?
What is your date of birth?
MM
/
DD
/
YYYY
What is your ethnicity?
What is your gender?
Do you have any physical or learning disabilities?
What is your current employment status?
Which area do you want to support?
Tell us about your idea (don't worry if you're not 100% sure yet, we'll explore this further together)
Tell us about you, why do you want to take part in this programme?
Due to Covid, we may have to deliver some activities online. Do you have the equipment, internet access and/or ability to join in with online activities? (If no, please explain why)
A space for any other ideas or comments that don't fit elsewhere
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Junction Point. Report Abuse