Questionnaire 16-17 - UK Commission on Bereavement

Invitation to young people aged 16-17 to take part

Thank you very much for your time and your thoughts. We really appreciate it. If you would like to complete the survey, please tick ALL the boxes below to give your permission *

I have read and understood the information about taking part and I want to do so
I have someone I trust to support me as I complete it
I understand that my data will be held and processed securely by Marie Curie on behalf of the UK Commission on Bereavement in line with data protection and GDPR
I understand that my information may need to be shared with the Local Authority/Health and Social Care Board (NI) in the event of any safeguarding concerns (as above)
I give permission for my anonymised answers to be included in reports and publications. I understand I will not be named in these.

Address

First Name *

Last Name *

Email Address *

Address 1 *

Address 2

Town / City *

Postcode *

Telephone number