Cycle Into Work Referral/Enquiry Form

Use this form to refer yourself or someone to the Cycle Into Work programme, or if you have a general enquiry.
If referring someone else, please make sure they have given permission to be contacted by us and note that all information will remain confidential and only be shared on a need-to-know or anonymised basis.
If booking on behalf of yourself- were you referred to this program by someone else?(Required)
If booking on behalf of yourself - Are you currently unemployed?(Required)
If you are referring someone else: Do we have permission from the person to be contacted directly?(Required)
Demographic information for Participant (If booking on behalf of someone else answer to the best of your knowledge or select “Prefer not to say” and participant will be asked directly if they wish to give this information)