Digital Mentoring Application

This form should be completed by the young person themselves; ideally alongside a parent, carer or guardian. The information provided will be confidential and treated in such a manner. Further information about our Digital Mentoring can be found on our website at www.wycombeyfc.org.uk/mentoring.

Priority will be given to young people who live or go to school within the Wycombe-Amersham-Marlow-Beaconsfield-Great Missenden areas. However, we will look to accommodate every request where possible.

If you are a school or professional that would like to refer a young person for Digital Mentoring, please contact us directly on erica@wycombeyfc.org.uk.

Finally, the use of your details will comply with GDPR regulations and you can find a copy of our privacy policy at www.wycombeyfc.org.uk/privacy-policy.

If you would prefer to complete a paper copy of the form, you can download it here and return it to us at erica@wycombeyfc.org.uk.

Please start with letting us know your name *

First

Last

What is your date of birth? *

What is your gender? *

What secondary school are you currently attending? *

What Year Group are you in? *

What is your email address? *

What is your address (including the postcode)? *

What is your parent, carer or guardians name? *

First

Last

What is your parent, carer or guardians telephone number? *

What is your your parent, carer or guardians email address? *

What is your parent, carer or guardians address (including the postcode)? (If different to that listed above)

What has prompted you to seek support through Digital Mentoring? (Please include brief details of any situations or emotions that you may be struggling with.) *

Are you receiving support from any other people or organisations? Please give brief details, if yes. (For example, School Pastoral Support, Councillors, CAMHS or Doctors.) *

What would you hope the outcome of receiving support would be? *

To be completed by young person and parent / carer / guardian: We confirm that we have read through the Wycombe Youth for Christ Digital Mentoring Information and we both consent to the support of this Digital Mentoring. *

Agreement of Parent / Carer / Guardian
Agreement of Young Person

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