YOU ARE HERE: Young people > 16-18? Tell us what you’re doing

Every year, Connexions Birmingham needs to contact all young people aged 16 to 18 to find out what they’re doing – to make sure that support is available if you need it. If you are in Birmingham and aged 16 to 18, please help us by filling in the survey below.

In order for Connexions Birmingham to stay in touch with you, we need up-to-date contact details, which is why we ask you for this information.

We offered a prize draw for completing this survey before 31 October – the 3 lucky winners of the High St Shopping Vouchers were Afifah from Stechford, Hazrat from Kitts Green and Linzi from Pype Hayes. Well done and thanks!

Data Protection
Information included in this questionnaire is covered under the Data Protection Act 1998. This information will be kept on your personal computerised record. You have the right to see the information we hold about you. In certain situations it may be of help to you if we can pass this information to others e.g. Employers, Training Providers, Sixth Forms and Colleges. Your Connexions Personal Adviser would discuss this with you and gain your permission.

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About you

EVERYBODY should fill in this section, please.

Name:
School currently or last attended:
Date of birth:
Address:
Phone:	Mobile:
Email:
Have you achieved 4 GCSEs at grade A, B or C? ...please select No Yes
How did you hear about this survey? ...please select Telephone message from Connexions Letter from Connexions Text from Connexions Browsing the Connexions website Other - please specify below
Details: (complete if “Other” was chosen above)
Please note: there may be times when we would try to contact you by email or mobile – please tick the appropriate box(es) if you do not want us to do this. I do not wish to be contacted by email. I do not wish to be contacted by mobile.

Now please decide which one of these 5 categories you are in, and click to move down to that section – please answer the questions in just that one section, and then follow the link down to the end of the form:

1. I am in full time employment (includes Apprenticeships)
2. I have a training place
3. I am continuing my education
4. I am unemployed and would like help from Connexions Birmingham
5. I am unemployed but do not want help from Connexions Birmingham

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1. I am in full time employment (includes Apprenticeships)

Name of employer:

Start date:

My job is:

My job will include: ...please select No training Training to NVQ1 Training to NVQ2 Training to NVQ3 Other training - please specify below

Other training: (complete if “Other training” was chosen above)

Now please jump to the Equal Opportunities section and the end of the form.

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2. I have a training place

Name of training provider:

Type of training: ...please select Work based learning e2e

Start date:

I am/will be training as:

This will lead to: ...please select Key Skills ASDAN Awards NVQ1 NVQ2

Now please jump to the Equal Opportunities section and the end of the form.

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3. I am continuing my education

Name of school sixth form/college:

Start date:

Course(s) being taken:

Course level (eg BTEC First, BTEC National, A Level):

Now please jump to the Equal Opportunities section and the end of the form.

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4. I am unemployed and would like help from Connexions Birmingham

I am looking for employment/training in this type of work:

Please note: what you tell us in this form is for information only – if you want assistance from Connexions Birmingham, please visit one of our Connexions Centres.

Now please jump to the Equal Opportunities section and the end of the form.

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5. I am unemployed but do not want help from Connexions Birmingham

Reason for not needing help: ...please select I am using other sources of help I am using another Connexions service Other reason - please specify below

Other reason: (complete if “Other reason” was chosen above)

Now please go on to the Equal Opportunities section (below) and the end of the form.

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...and finally, the Equal Opportunities stuff

To ensure that our Equal Opportunities Policy is being carried out, we would be grateful if you would complete the following section – please use the three drop-down choices to tell us about you.

What sex are you?	...please select Male Female Prefer not to say
What is your ethnic origin?	...please select White – British White – Irish White – any other White background Mixed – White & Black Caribbean Mixed – White & Black African Mixed – White & Asian Mixed – any other mixed background Black – Caribbean Black – African Black – any other Black background Indian Pakistani Bangladeshi Afghan Kurdish Iranian Kosovan Somalian Chinese Any other Asylum Seeker/Refugee Any other Ethnic background Prefer not to say
Do you have a disability or health problem which might be relevant?	...please select No Yes Prefer not to say
Nature of disability/health problem: (complete if “Yes” was chosen above)

Thanks for taking the time to help us with this form – finally all you have to do now is press the “Send” button below. After you press “Submit my survey” you’ll get a summary of what you’ve told us. Use our menu system to get back to browsing our website.