Refer a customer for Digital Inclusion Support

This form is intended for library staff and volunteers to complete.

Please complete this form to refer a customer to the Digital Inclusion Support Pilot.

See our Privacy Notice for information on how we process your information.

There is a problem

Customer's name *

Customer's phone number

Customer's email

Customer has given consent to share data *

Yes, the customer has given permission to share, store and process their data

Notes

Referrer's name *

Referrer's Team *

Referrer's Department *