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Helix Support Contact Form

Sign up for available support

1: *Forename 
*Forename must be provided
2: *Surname 
*Surname must be provided
3: *Address line 1 
*Address line 1 must be provided
Select Address (Google)  Clear Address
7: *Postcode 
*Postcode must be provided
8: *Mobile number 
*Mobile number must be provided
9: *Email address 
*Email address must be provided
10: *Date of Birth 
*Date of Birth must be provided
11: *Gender 
*Gender must be provided
12: *Ethnic Origin 
*Ethnic Origin must be provided
13: *Reason for getting in touch 
*Reason for getting in touch must be provided   
*Reason for getting in touch
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14: How did you hear about us? 
How did you hear about us?
15: Are you wanting support from the Health and Social Care Team to get a job in that sector? 
Are you wanting support from the Health and Social Care Team to get a job in that sector? must be provided

* Data Protection Notes


In order to provide an effective service to help you achieve your goals, we need to record and store data about you.

I confirm that I am happy for Capital City Partnership to hold the information given in this form in order to provide me with an employability service.
I understand that, should I not be accepted into the service or decide not to use the service, then Capital City Partnership may send me details of another service that I may be eligible for. Further details of where the data is held, what it is used for and with whom it might be shared is available at https://helix.scot/helix-mis-privacy-notice

I understand that I have the right to withdraw my data, in which case I can contact: Joe Mountford-Smith, New Futures Coordinator,165a Leith Walk, Edinburgh, EH6 8NR, joe.mountford@capitalcitypartnership.org.
Do you agree to the data protection terms and conditions?
Client:
Date: ......................... Signed: .......................................
Caseload:
Date: ......................... Signed: .......................................