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Your first name
Your last name
Date of birth
*
(dd/mm/yyyy)
Home address
*
Postcode
*
Telephone number
*
Please enter the mobile or landline number you would like us to call you on
What is the main issue you need support with?
Please choose one
Preparing for and/or looking for a job, apprenticeship, course or training course (for young people not in education, employment or training)
Emotional and mental wellbeing
Building confidence, self-esteem and resilience
Recognising and developing safe and healthy relationships
Independent living skills
Sexual health
Smoking, substance and/or alcohol misuse
Understanding the risks of involvement violence, gangs, crime or antisocial behaviour
Being excluded from school
Getting involved in volunteering or helping in the community
Getting involved local decision-making, including planning of local services for young people
Please tell us about any additional issues you would like support with
Are you currently getting any other support?
For example, from a social worker, mental health professional, Specialist Adolescent Service Hertfordshire (SASH) or another agency.
Yes
No
Name of service and/or practitioner
Please select any that apply to you
I have learning difficulties and/or disabilities
I am a young parent/parent-to-be
I am care experienced
I identify as LGBT+
I am a young carer
I am eligible for free school meals
I am a refugee or asylum seeker
I am involved in the Youth Justice Service
Are you:
*
Attending a school or college
Being home-educated
Currently not in education, employment or training
Other
If you are attending school or college, please state which one
Please tell us more about your current situation
with regards to education, training and employment
Please tell us how you heard about Services for Young People
Internet search/website
School/college
Social media
Word of mouth
Event
Newspaper
Poster
Other
Please tell us more about how you heard about Services for Young People
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