Support Request & Consent Form
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Thank you for reaching out to the Exit Hate Trust as people you can trust and get help from.

Seeking to support people in need, our guidance comes from a place of lived experience. Initially, we need you to complete this form and then from the information you give us, we will contact you about what support we can offer you. 

This may take between 7-10 working days for a review to take place, depending on what you have told us.

Initially one of our team will contact you, by your preferred communication method, because we want you to feel comfortable and we will have an initial conversation about what information you have given us, so we have a clear picture of your current situation and needs.

From this interaction, we will review what you have said and come back to you as soon as possible and let you know what support we can offer you.

Support can range from a couple of calls/emails to the allocation of a support worker who will provide a dedicated 121-individual mentoring support programme by someone who understands and won't judge.

All our support is provided, by a small team of dedicated part-time staff and volunteers, so please keep this in mind when contacting us. During communication with us and the potential support offered, you may receive several additional information requests, which do require your completion. To do this we do require an email address.

FYI our team includes former far-right activists, who have now walked away from our past, families who have had a loved one involved and professionals who care and work in this field.

Exit Hate UK Ltd is a charity (1197666), and operates under the working name - Exit Hate Trust, we are non-judgmental and non-political.

To aid our support, as stated we do need a contact email, so we can send you information requests and also other support items. For this you can use one you already have or create a new one, it's up to you.

* PLEASE NOTE: Operating with a duty of care, If anyone talks about committing harm to themselves or others, we may seek outside assistance, advice or support from other agencies. 

Reaching out for help, we know is a huge step, so thank you for contacting us and well done!

Understanding you may not wish to give us your real name, this is fine, we get it.

However, to offer you support we do need you to confirm and agree that you wish to receive our support and that you understand how we operate and what we expect from people, so please complete the form below, using a different chosen name if you prefer.

If you need to contact us you can via email at: info@exithate.org or call 0800 999 1945.

OUR WORK EXPLAINED 

CONFIDENTIALITY

We highly respect the privacy and confidentiality of all of our clients. We likewise believe that for mentoring to be effective, we must make our clients feel secure about the information that they disclose to us. We keep all client's records in a secure manner and we do not allow them to be accessed or shared with anyone else outside our charity unless this is with the written consent of our client or we are requested to do so by law. If records receive no update within a period of 12 months, we delete all our case records for people's privacy and protection, except your chosen name, email and case number. This is so if you reach out to us again, we can confirm you have previously used our services.

However, privacy has limitations in law and we would like to inform you of the circumstances where we may share information with a 3rd party agency without your consent and this is if we hear any information which relates to:

Acts of sexual/physical/emotional abuse or misconduct
Acts that a mentor believes may cause harm to yourself or others
Any criminal activity
Compelling legal orders by a court or law enforcement officer
In the case of a client being below legal age, we may have to disclose information to parents or legal guardians to safeguard the individual being supported from harm.

THE MENTORING SESSION

Our mentoring process is carried out via a 121 informal meeting, either online or over the phone and lasts for about 45 minutes, no more. This takes place with one of our team who will either have lived experience of the impact of far-right extremism on their personal lives or be a professional who cares and wants to reduce the damage extremism does to individuals involved or families with a loved one involved.

Providing advice from this perspective, we seek to help clients learn about themselves, have open and frank conversations and seek to understand society without being trapped by an ideology which causes harm.

AUTHORISED CONSENT 

I hereby confirm I have read all the information provided, that I understand it and wish to receive support from the Exit Hate Trust  on a voluntary basis under these conditions. 

I understand I may withdraw from this engagement support at any time and that I must inform Exit Hate of this via email. I understand I do not have to give any reasons if I do not wish to.

I agree to comply with a well-being plan if developed which will aim to support me on my journey.

I agree to be respectful at all times and never use abuse of any kind.                  

I understand if I do, that support may be changed or even withdrawn.                                    

I agree to attend all appointments made or notify my mentor ASAP if something happens and I am not able to participate in my mentoring support session. I understand that failure to attend 2 booked sessions, may result in my support being changed/cancelled. 

I understand that my mentor may offer me links to other services they feel may help me and that Exit may cease support to me if I do not look at and engage with any recommended support suggested.

I confirm I am not a journalist seeking information for research or for use in a film/documentary. (If you are a journalist, please ask us directly for assistance)

I understand that extracts of client's stories without any personal details may be used to highlight the impact and need for Exit Hate's services.  If you do not want us to potentially use any anonymised details, can you please notify us via email at: info@exithate.org

Please tick as appropriate *
Required
How are you feeling?Please can you tell us if you are experiencing any of the following feelings.
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Required
Would you like to receive information about organisations who can help you with any of the above?
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Are you currently receiving support from someone else 
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Required
How did you hear about us?
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Where do you live in the UK?
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Are you or a family member currently involved in supporting an extremist group or ideology?
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Do you / they wish to leave extremism and rebuild their lives?
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Name or chosen name
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What is today's date? *
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What is your phone number? *
What is your email? *
Additional comment(s)

Would you like to sign up for our KIT (Keep In Touch) programme after your support has finished? Here we contact you 3 times to see how you are for 12 months after our support has finished. i.e., - April, August & December.
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