Use this form to capture details about the people you meet through community development work as part of the RIC/CLICS programme.
This information will be used to help us understand what support needs there are within our communities which might not currently be met. This will help to build an accurate understanding of the people we serve so that all our activities, opportunities and policies are fair and can be delivered to meet the needs of everybody. 
Please do not provide any personal/identifiable information on this form.

If the person wishes to be contacted again by your service there is an option at the end of the form to note that they have agreed - but you will need to record their contact details on a separate sheet. If so, you will need to create a Unique Reference for the person so that you can easily match this form to their contact details. This URN will need to be added to the end of this form