Oxford United in the Community 'Let's Tackle Loneliness Together'

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You are participating in the ‘Tackling Loneliness Together programme’ commissioned by EFL Trust and delivered by your local Community Club Organisation (CCO). The programme is funded by Department for Digital, Culture, Media and Sport (DCMS) and will be evaluated by EFL Trust and DCMS.

Oxford United in the Community (OUitC), EFL Trust, DCMS and an Independent Evaluator (TBD by DCMS) wish to obtain your explicit consent to process information about you for the following purpose:

- In order to evidence the level of participation on the programme, to draw down and continue programme funding, to understand the effect of Covid-19 on loneliness, and to explore whether the programme is achieving its intended outcomes.

All the information we hold about you will be shared anonymously and aggregated (not individual data) with EFL Trust, DCMS and the independent evaluator for research and evaluation purposes only. We may process your information for other purposes (such as keeping you safe) where the law allows us to do so and where we do not require your consent.

This form is used to provide a nomination for a Relative, Friend or Neighbour who is over 70 and would like to receive a friendly phone call from one our members of the team at Oxford United in the Community.
If you have also enquired about the OUitC Virtual Coffee Morning then you will also need to complete this form.

Full Name of the person you would like to nominate *

Date of Birth of the person you would like to nominate *

YYYY

Please state the postcode of the person you would like to nominate . *

Please state the contact number of the person you would like to nominate. *

Would you say the person you would like to nominate has a Disability? *

Yes

Prefer not to say

Which one of the following Gender, best describes the person you would like to nominate? *

Male

Female

Non Binary

Prefer not to say

Other:

Which one of the following ethnic group or background best describes the person you would like to nominate? *

White

Mixed

Black or Black British

Asian or Asian British

Other:

Which of these best describes the sexual orientation of the person you would like to nominate? *

Bisexual

Gay/Lesbian

Hetrosexual/Straight

Prefer not to say

Other:

Please state if you are completing this form for the friendly phone call service or the Virtual coffee morning or both? *

Friendly phone call service

Virtual Coffee Morning via Zoom

both

Please State the email address of the person providing the nomination *

Thank You

As we are relying on your explicit consent to use this information, you may withdraw your consent at any time whilst this data remains identifiable. In order to withdraw consent, please contact:

By post: By Email:
Oxford United in the Community Manorclubextra@oufc.co.uk
Kassam Stadium
Grenoble Road
Oxford
OX4 4XP

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