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If you are an organisation that provides information, advice, counselling or support to young people between the ages of 11-25 and would like an entry in our Directory of Services, please complete the following form.

* denotes a required field

Contact Details

Organisation*: Address*: Address: Town*: County*: Post Code*: Code:
Telephone 1*: Telephone 2:

Phone numbers must contain no more than one space and a maximum of 14 characters

Email 1*: Email 2: Website:

Service Information

Age range of young people you see*:
Do you see all young people*:

Opening Times for Young People

Monday*: Tuesday*: Wednesday*: Thursday*: Friday*: Weekends*:

Services Provided

Referral Services*:

Advice

Counselling

Information

Other Support:

Advocacy

Education/Training

Mediation

Mentoring

In which of the following subject areas do you provide help?:

Abuse

Benefits/Money/Debt

Bullying

Careers

Crime/Problems with police

Depression/Anxiety

Drugs and Alcohol

Eating Disorders

Education Rights

Employment Rights

Family and relationships

Housing/Homelessness

Identity/Self Esteem

Immigration/Asylum support

Mental Illness

Sexual Health

Suicide/Self Harm

Point of Contact

Contact person for Youth Access*:
Job Title*: Direct email address*:

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