SUBJECT DISCLOSURE REQUEST FORM

Subject Disclosure Request Form
If you are a professional seeking data about an individual who has accessed the Lucy Faithfull Foundation services, please complete this form. We will only share relevant information, where there is a clear lawful basis to do so.

To confirm an individual has completed one of our psycho-educational programmes (Inform Plus, Engage Plus, Inform, Inform Young People) and what areas of work were addressed, we suggest you seek a copy of their completion letter directly from the participant themself. If this is not possible, you can request a copy from us by completing the below form. Please note that informed consent from the data subject is required.

Our programmes do not assess a participant’s risk to children or their ability to protect children, nor do we assess an individual’s level of engagement with a programme. Consequently, we are not able to provide any information which comments on these areas.
Name of individual*

First NameMiddle NameLast Name
Date of Birth of individual*

DayMonthYear
Date
Previous name of individual (if applicable)

First NameMiddle NameLast Name
Please provide information about the service(s) the person received from us, and if known their unique ID (Salesforce) number given.
Reason for the request*
Requested information*
Organisation name & address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Requester name*

First NameLast Name
Requester job position*
Requester email address*
example@example.com
Requester phone number*

Area CodePhone Number
Will the individual provide consent?*

YesNo
Provide the GDPR Section you are relying on for consent exemption
Please upload a consent form signed by the individual, this document should also contain a copy of their photo ID

Cancelof
Preferred required by date

DayMonthYear
Date
How would you like to receive the response?*

Secure EmailPost
Upload a copy or photo of your professional ID card, or alternative relevant documentation (e.g. a court order)*

Cancelof
I confirm that I am authorised to request a Subject Disclosure on behalf of my organisation*

Yes
Requester signature*

Clear
Should be Empty:

Subject Disclosure Request Form