What We Do Services Drop-In Centre Registration form Contact Details and Information When you complete this form, we ask you for permission to store your information. Please see the section at the end regarding data protection (GDPR). Please complete as much of this form as possible. The more information we have, the easier it will be to assist you. It only takes a couple of minutes. About You First name * Last name * Email * Phone * Address * Date of Birth Gender * Male Female Transgender Other Nationality * Unknown Stateless Abkhaz Afghan Albanian Algerian American American Samoan Andorran Angolan Anguillan Antiguan Argentinian Armenian Aruban Australian Austrian Azerbaijani Bahamian Bahraini Bangladeshi Barbadian Barbudan Belarusian Belgian Belizean Beninese Bermudian Bhutanese Bolivian Bosnian Botswanan (Motswana) Brazilian British British (Overseas) British Virgin Islander Bruneian Bulgarian Burkinabé Burmese Burundian Cambodian Cameroonian Canadian Cape Verdean Caymanian Central African Chadian Chagossian Chechen Chilean Chinese Colombian Comorian Congolese Congolese (DRC) Congolese (Rep of Congo) Costa Rican Croatian Cuban Cypriot Czech Danish Djibouti Dominican Dutch Ecuadorian Egyptian Emirati English Equatorial Guinean Eritrean Estonian Ethiopian EU citizen Falkland Islander Faroese Fijian Filipino Finnish French French Guianese French Polynesian Gabonese Gambian Georgian German Ghanaian Gibraltarian Greek Greenlandic Grenadian Guadeloupe Guamanian Guatemalan Guinean Guinean (Guinea) Guinean (Guinea-Bissau) Guyanese Haitian Honduran Hongkongese Hungarian Icelandic Indian Indonesian Iranian Iranian (Kurdish) Iraqi Irish Israeli Italian Ivorian Jamaican Japanese Jordanian Kashmiri Kazakh Kenyan Korean Kosovar Kuwaiti Kyrgyz Laotian Latvian Latvian (alien passport) Lebanese Lesotho (Basotho) Liberian Libyan Liechtensteiner Lithuanian Luxembourgish Macanese Macedonian Malagasy Malawian Malaysian Maldivian Malian Maltese Manx Mauritian Mexican Micronesian Moldovan Mongolian Moroccan Mosotho Motswana Mozambican Namibian Nepali New Zealand Nicaraguan Nigerian Nigerien (Niger) Northern Irish Norwegian Omani Pakistani Palestinian Panamanian Papua New Guinean Paraguayan Peruvian Polish Portuguese Puerto Rican Qatari Romanian Russian Rwandan Salvadoran Samoan Saudi Scottish Senegalese Serbian Sierra Leonean Singaporean Slovak Slovenian Somali South African South Korean South Sudanese Spanish Sri Lankan St Lucian Sudanese Swazi Swedish Swiss Syrian Taiwanese Tajikistani Tanzanian Thai Timorese Tobagonian Togolese Tongan Trinidadian Tunisian Turkish Turkmen Ugandan Ukrainian Uruguayan Uzbek Venezuelan Vietnamese Vincentian Welsh Yemeni Zambian Zimbabwean Lanuguages Spoken Albanian Amharic Arabic Bengali Chinese English Farsi French Georgian Kurdish Pashto Portuguese Punjabi Romanian Russian Somali Swahili Urdu Other Current Immigration Status --None-- Asylum Seeker I have refugee status I have subsidiary protection I have permission to remain Student - Stamp 2 Undocumented Stateless Irish Citizen I have received a deportation order Other Department of Justice Reference No. (Person ID) Personal Public Service Number (PPSN) Relationship Status --None-- Civil Partnership Divorced Married Unmarried Partner Separated Single Widowed Other Do you have a solicitor? YES NO Do you have any children under the age of 18? NO YES Number of children in Ireland --None-- 1 2 3 4 5 6 7 8 Number of children outside of Ireland --None-- 1 2 3 4 5 6 7 8 What is your question or query? How can we help? Do you require support from other Irish Refugee Council Services? Housing Support Employment and Training Support Education Support Legal Support Other How would you like us to contact you? Any Phone Email WhatsApp GDPR (General Data Protection Regulation) In May 2018, the European Union (EU) introduced a new law (Regulation 2016/679) on data protection and privacy for all individuals living within the EU. This means that any organisation that requests personal information from you must ask for your permission and explain to you how they will store and/or share that information. It is therefore required that we ask for your consent to collect and record your data via this form. Continue scrolling to see the rest of the GDPR statement >> If you do not give us permission to collect and store your data, it is not possible to for us to work with you or on your behalf. Please read our data protection statement in full here: INTRODUCTION: This document explains your rights in relation to your personal information, known as data, that the Irish Refugee Council processes (stores, collects or records). It also explains the obligations on us if you give us consent to store your data. YOUR DATA: It is necessary for the Irish Refugee Council, in its work supporting you and protecting and advancing your interests in relation to your application for asylum, a family reunification application, your accommodation, education and employment needs or other issues relating to your integration into Irish society, to keep data relating to you. This personal data includes: Name, address, phone and email Gender Age It may also be necessary to process special, sensitive personal data relating to: Your racial or ethnic origin Political opinions, religious or philosophical beliefs, or trade union membership Data concerning health or data concerning a natural person's sex life or sexual orientation Housing and accommodation issues Reasons why you have left your country and cannot return We also record when and how we help you. For example that we gave you information and advice on a particular subject on a particular day. WHERE DO WE HOLD THIS DATA? This information is stored on folders on our computers that are password protected. It is also stored on a database called Salesforce that is password protected. It is also stored in paper format in locked filing cabinets. CONSENT Your personal data belongs to you alone and we can only use your data when you give us explicit consent. Below we ask you to give consent to keep your data. You can withdraw your consent at any time. To do so please write to the Data Controller, Irish Refugee Council, 37 Killarney Street, Dublin 1 requesting your data. We will respond and acknowledge your withdrawal in 30 days and your data will be destroyed. HOW WILL YOU USE MY DATA? Your data will be used for the purpose of providing you with an advocacy and support service in relation to your application for asylum, a family reunification application, your accommodation, education and employment needs or other issues relating to your integration into Irish society. We will also use anonymised data for the purposes of research and statistical monitoring. WHO IS IN CHARGE OF MY DATA? A Data Controller is someone who is responsible for your data and who must make sure that your data is processed according to the law. For example they are responsible for making sure that the information held about you is accurate and that it is kept secure. The CEO of the Irish Refugee Council, Nick Henderson, is the Data Controller. His email address is: [email protected] and telephone number is 01 7645854. WILL WE SHARE YOUR DATA? Everything you tell us will be treated confidentially, however we may suggest that you go to another organisation for advice or support because they will be better able to help you with all or part of your needs. We are able to refer you to them and help get you an appointment. Ideally we would also give them the information you have given us with your permission. If you give consent below, you are agreeing that we may refer you to other local service providers; make appointments with other advice providers on your behalf; share your personal information with other service providers so that they have initial information about you and your possible needs. SHARING YOUR DATA WITH THE IRISH GOVERNMENT AND RELEVANT AGENCIES It may also be necessary for us to make submissions, statements, representations to the Irish Government and relevant agencies such as the International Protection Office in order to further your application for international protection/family reunification/other. We will never share your data with the Irish Government without your prior written consent. If we need to contact the Irish Government on your behalf, a caseworker will discuss this with you directly and obtain your prior written consent (with signature) in the form of a letter of authority. Please see an example of a letter of authority here: [Date] I, [insert name], give the Irish Refugee Council’s drop in service permission to communicate with The International Protection Accommodation Service (IPAS) on my behalf in relation to accommodation. [signature] SHARING YOUR DATA WITH THE DEPARTMENT OF JUSTICE It may also be necessary for us to make submissions, statements, representations to the Department of Justice to further your application for international protection/family reunification/other. You will be asked to give specific consent to us to share this data. CAN I WITHHOLD MY CONSENT? Yes you can. We will not record your information unless you provide your consent for us to do so. However we may not be in a position to support you further without your consent if you are to be registered for our service as some information is required for us to be able to support you. HOW LONG WILL WE HOLD YOUR DATA FOR? It is necessary to hold data about you for 6 years. This is because your case may require assistance over a period of time. For example it can take several years for an application for asylum to be decided and you may also have queries around education, employment, accommodation or family reunification after a decision has been made on your claim. You may also need assistance in the future, on another matter, and it helps us to have information about you to refer to. After 6 years your data will be destroyed either by being deleted if on a computer or shredded if in paper format. CAN I HAVE A COPY OF THE DATA WE HOLD? You have a right to ask for a copy of your information and to correct any inaccuracies. Please write to the Data Controller, Irish Refugee Council, 37 Killarney Street, Dublin 1 requesting your data. We will respond in 30 days. WHO DO I COMPLAIN TO IF I AM UNHAPPY ABOUT HOW MY DATA HAS BEEN STORED? You have a right to complain if you are unhappy about how you think your data has been handled. Please write to the Data Controller, Irish Refugee Council, 37 Killarney Street, Dublin 1 requesting your data. We will respond in 30 days. You can also write to the Data Protection Commissioner. CORRECTING MISTAKES IN MY DATA You also have the right to correct mistakes in the data that we hold about you. To do so, please write to the Data Controller, Irish Refugee Council, 37 Killarney Street, Dublin 1 requesting your data. We will respond in 30 days. Please tick this box to confirm that you have carefully read our data protection statement. Ticking the box indicates that you agree with the contents of the statement allowing us to keep and share your details for the purpose of providing you with an advocacy and support service in relation to your application for asylum, a family reunification application, your accommodation, education and employment needs or other issues relating to your integration into Irish society. In the event we have to advocate for you vis-à-vis the Irish Government, we will contact you in advance in order to obtain a letter of authority from you. Unless you consent to us storing and collecting your data we cannot assist you. * I AGREE
Contact Details and Information When you complete this form, we ask you for permission to store your information. Please see the section at the end regarding data protection (GDPR). Please complete as much of this form as possible. The more information we have, the easier it will be to assist you. It only takes a couple of minutes. About You First name * Last name * Email * Phone * Address * Date of Birth Gender * Male Female Transgender Other Nationality * Unknown Stateless Abkhaz Afghan Albanian Algerian American American Samoan Andorran Angolan Anguillan Antiguan Argentinian Armenian Aruban Australian Austrian Azerbaijani Bahamian Bahraini Bangladeshi Barbadian Barbudan Belarusian Belgian Belizean Beninese Bermudian Bhutanese Bolivian Bosnian Botswanan (Motswana) Brazilian British British (Overseas) British Virgin Islander Bruneian Bulgarian Burkinabé Burmese Burundian Cambodian Cameroonian Canadian Cape Verdean Caymanian Central African Chadian Chagossian Chechen Chilean Chinese Colombian Comorian Congolese Congolese (DRC) Congolese (Rep of Congo) Costa Rican Croatian Cuban Cypriot Czech Danish Djibouti Dominican Dutch Ecuadorian Egyptian Emirati English Equatorial Guinean Eritrean Estonian Ethiopian EU citizen Falkland Islander Faroese Fijian Filipino Finnish French French Guianese French Polynesian Gabonese Gambian Georgian German Ghanaian Gibraltarian Greek Greenlandic Grenadian Guadeloupe Guamanian Guatemalan Guinean Guinean (Guinea) Guinean (Guinea-Bissau) Guyanese Haitian Honduran Hongkongese Hungarian Icelandic Indian Indonesian Iranian Iranian (Kurdish) Iraqi Irish Israeli Italian Ivorian Jamaican Japanese Jordanian Kashmiri Kazakh Kenyan Korean Kosovar Kuwaiti Kyrgyz Laotian Latvian Latvian (alien passport) Lebanese Lesotho (Basotho) Liberian Libyan Liechtensteiner Lithuanian Luxembourgish Macanese Macedonian Malagasy Malawian Malaysian Maldivian Malian Maltese Manx Mauritian Mexican Micronesian Moldovan Mongolian Moroccan Mosotho Motswana Mozambican Namibian Nepali New Zealand Nicaraguan Nigerian Nigerien (Niger) Northern Irish Norwegian Omani Pakistani Palestinian Panamanian Papua New Guinean Paraguayan Peruvian Polish Portuguese Puerto Rican Qatari Romanian Russian Rwandan Salvadoran Samoan Saudi Scottish Senegalese Serbian Sierra Leonean Singaporean Slovak Slovenian Somali South African South Korean South Sudanese Spanish Sri Lankan St Lucian Sudanese Swazi Swedish Swiss Syrian Taiwanese Tajikistani Tanzanian Thai Timorese Tobagonian Togolese Tongan Trinidadian Tunisian Turkish Turkmen Ugandan Ukrainian Uruguayan Uzbek Venezuelan Vietnamese Vincentian Welsh Yemeni Zambian Zimbabwean Lanuguages Spoken Albanian Amharic Arabic Bengali Chinese English Farsi French Georgian Kurdish Pashto Portuguese Punjabi Romanian Russian Somali Swahili Urdu Other Current Immigration Status --None-- Asylum Seeker I have refugee status I have subsidiary protection I have permission to remain Student - Stamp 2 Undocumented Stateless Irish Citizen I have received a deportation order Other Department of Justice Reference No. (Person ID) Personal Public Service Number (PPSN) Relationship Status --None-- Civil Partnership Divorced Married Unmarried Partner Separated Single Widowed Other Do you have a solicitor? YES NO Do you have any children under the age of 18? NO YES Number of children in Ireland --None-- 1 2 3 4 5 6 7 8 Number of children outside of Ireland --None-- 1 2 3 4 5 6 7 8 What is your question or query? How can we help? Do you require support from other Irish Refugee Council Services? Housing Support Employment and Training Support Education Support Legal Support Other How would you like us to contact you? Any Phone Email WhatsApp GDPR (General Data Protection Regulation) In May 2018, the European Union (EU) introduced a new law (Regulation 2016/679) on data protection and privacy for all individuals living within the EU. This means that any organisation that requests personal information from you must ask for your permission and explain to you how they will store and/or share that information. It is therefore required that we ask for your consent to collect and record your data via this form. Continue scrolling to see the rest of the GDPR statement >> If you do not give us permission to collect and store your data, it is not possible to for us to work with you or on your behalf. Please read our data protection statement in full here: INTRODUCTION: This document explains your rights in relation to your personal information, known as data, that the Irish Refugee Council processes (stores, collects or records). It also explains the obligations on us if you give us consent to store your data. YOUR DATA: It is necessary for the Irish Refugee Council, in its work supporting you and protecting and advancing your interests in relation to your application for asylum, a family reunification application, your accommodation, education and employment needs or other issues relating to your integration into Irish society, to keep data relating to you. This personal data includes: Name, address, phone and email Gender Age It may also be necessary to process special, sensitive personal data relating to: Your racial or ethnic origin Political opinions, religious or philosophical beliefs, or trade union membership Data concerning health or data concerning a natural person's sex life or sexual orientation Housing and accommodation issues Reasons why you have left your country and cannot return We also record when and how we help you. For example that we gave you information and advice on a particular subject on a particular day. WHERE DO WE HOLD THIS DATA? This information is stored on folders on our computers that are password protected. It is also stored on a database called Salesforce that is password protected. It is also stored in paper format in locked filing cabinets. CONSENT Your personal data belongs to you alone and we can only use your data when you give us explicit consent. Below we ask you to give consent to keep your data. You can withdraw your consent at any time. To do so please write to the Data Controller, Irish Refugee Council, 37 Killarney Street, Dublin 1 requesting your data. We will respond and acknowledge your withdrawal in 30 days and your data will be destroyed. HOW WILL YOU USE MY DATA? Your data will be used for the purpose of providing you with an advocacy and support service in relation to your application for asylum, a family reunification application, your accommodation, education and employment needs or other issues relating to your integration into Irish society. We will also use anonymised data for the purposes of research and statistical monitoring. WHO IS IN CHARGE OF MY DATA? A Data Controller is someone who is responsible for your data and who must make sure that your data is processed according to the law. For example they are responsible for making sure that the information held about you is accurate and that it is kept secure. The CEO of the Irish Refugee Council, Nick Henderson, is the Data Controller. His email address is: [email protected] and telephone number is 01 7645854. WILL WE SHARE YOUR DATA? Everything you tell us will be treated confidentially, however we may suggest that you go to another organisation for advice or support because they will be better able to help you with all or part of your needs. We are able to refer you to them and help get you an appointment. Ideally we would also give them the information you have given us with your permission. If you give consent below, you are agreeing that we may refer you to other local service providers; make appointments with other advice providers on your behalf; share your personal information with other service providers so that they have initial information about you and your possible needs. SHARING YOUR DATA WITH THE IRISH GOVERNMENT AND RELEVANT AGENCIES It may also be necessary for us to make submissions, statements, representations to the Irish Government and relevant agencies such as the International Protection Office in order to further your application for international protection/family reunification/other. We will never share your data with the Irish Government without your prior written consent. If we need to contact the Irish Government on your behalf, a caseworker will discuss this with you directly and obtain your prior written consent (with signature) in the form of a letter of authority. Please see an example of a letter of authority here: [Date] I, [insert name], give the Irish Refugee Council’s drop in service permission to communicate with The International Protection Accommodation Service (IPAS) on my behalf in relation to accommodation. [signature] SHARING YOUR DATA WITH THE DEPARTMENT OF JUSTICE It may also be necessary for us to make submissions, statements, representations to the Department of Justice to further your application for international protection/family reunification/other. You will be asked to give specific consent to us to share this data. CAN I WITHHOLD MY CONSENT? Yes you can. We will not record your information unless you provide your consent for us to do so. However we may not be in a position to support you further without your consent if you are to be registered for our service as some information is required for us to be able to support you. HOW LONG WILL WE HOLD YOUR DATA FOR? It is necessary to hold data about you for 6 years. This is because your case may require assistance over a period of time. For example it can take several years for an application for asylum to be decided and you may also have queries around education, employment, accommodation or family reunification after a decision has been made on your claim. You may also need assistance in the future, on another matter, and it helps us to have information about you to refer to. After 6 years your data will be destroyed either by being deleted if on a computer or shredded if in paper format. CAN I HAVE A COPY OF THE DATA WE HOLD? You have a right to ask for a copy of your information and to correct any inaccuracies. Please write to the Data Controller, Irish Refugee Council, 37 Killarney Street, Dublin 1 requesting your data. We will respond in 30 days. WHO DO I COMPLAIN TO IF I AM UNHAPPY ABOUT HOW MY DATA HAS BEEN STORED? You have a right to complain if you are unhappy about how you think your data has been handled. Please write to the Data Controller, Irish Refugee Council, 37 Killarney Street, Dublin 1 requesting your data. We will respond in 30 days. You can also write to the Data Protection Commissioner. CORRECTING MISTAKES IN MY DATA You also have the right to correct mistakes in the data that we hold about you. To do so, please write to the Data Controller, Irish Refugee Council, 37 Killarney Street, Dublin 1 requesting your data. We will respond in 30 days. Please tick this box to confirm that you have carefully read our data protection statement. Ticking the box indicates that you agree with the contents of the statement allowing us to keep and share your details for the purpose of providing you with an advocacy and support service in relation to your application for asylum, a family reunification application, your accommodation, education and employment needs or other issues relating to your integration into Irish society. In the event we have to advocate for you vis-à-vis the Irish Government, we will contact you in advance in order to obtain a letter of authority from you. Unless you consent to us storing and collecting your data we cannot assist you. * I AGREE