SPSAS Databank Application Form

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Email *

First Name *

Second Name *

Current Address (please include town) *

Postcode *

Phone Number *

Email Address *

Do you already have an 02 Sim Card / O2 number? *

yes

Do you have a Vodafone Sim Card / Number *

Yes

Do you have a Three Sim Card / Number *

Yes

Can you confirm you have a device you can put this data sim into, for example, phone / tablet/ mifi device? *

Yes

Do you need this data for up to 6 months? Please specify how long it is needed for *

Can you confirm that you are from a low income household *

Can you confirm that either you have no or insufficient access to internet at home, no or insufficient access to internet when away from your home or cannot afford your monthly contract or top up *

I have none or insufficient access to internet at home

I have none or insufficient access to internet away from my home

I cannot afford my monthly contract or to keep topped up for datqa

Do you have a preference depending on your signal area to which network we provide you data with? (please note there maybe a waiting time depending on which network you choose and if we have the sims available as we have to order these a month in advance) *

Vodafone

Three

Is there anything else you would like us to know? *

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