If you need any help with this form, you can call us on 0300 222 5742.
You must answer all the questions marked with an asterisk (*).
You need to be at least 16 years old to attend the Kickstart service. On our website you can find advice for disabled job seekers and disabled people in work or you can call our helpline for advice on 0808 800 3333.
Kickstart is a service for disabled people.
Kickstart is only available to people living in these areas. You can find advice for disabled people looking for work and disabled people in work or find out about our national Support to Work service.
You can also call our helpline for advice on 0808 800 3333.
To use this service we’d like to contact you by phone and by email before arranging a face to face meeting. Please tell us if you have any access requirements.
We will not use your details for marketing or fundraising.