CLA Data Bank

Name *

First

Last

Date of Birth *

Ethnicity *

Gender *

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Preferred Method of Contact

Phone
Email
Mail

Which Local Authority were responsible for your Care?

Type of Placement

Foster Care
Residential Care
Kinship Care
Other

What is your Leaving Care Status?

Currently in Care
Care Leaver (16-25)
Care Leaver (25+)

How did you hear about the Data Bank?

Facebook
Instagram
CLA Bulletin
X (Twitter)
Other

Which Data Pack would you like to apply for?

O2 25GB (Top up Voucher)
Three 24BG (Sim Card Data only – Recommended for dongles and tablets)
Vodaphone 40GB (Sim Card – 6 months of Data, Minutes and Texts)
X (Twitter)
Other

Data Email Data

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Last

GDPR Email Name

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I consent to allowing The Care Leavers Association to store my submitted information so they can respond to my inquiry.

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