Social Inclusion Voucher Scheme 2023 APPLICATION FORM InstagramThis field is for validation purposes and should be left unchanged.Personal DetailsName of Deaf ISL User:(Required) First Last Mobile Number(Required)Email(Required) Address(Required) Address Line 1 Address Line 2 City/Town County Eircode Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Gender(Required) Female Male Prefer not to say Other Age Group(Required) 18-24 years 25-34 years 35-44 years 45-54 years 55-64 years 65 years and older Do you identify with the following:(Required) Deaf-Blind Member of the Traveller Community 65+ years Ethnic Minority Migrant Deaf with a disability or with additional needs None of the above Event InformationCategory of Event(Required) Social Cultural Medical Public events and services Educational and training events Other Date of Event(Required) Day Month Year Start Time(Required) Hours : Minutes Estimated finish(Required) Hours : Minutes Location(Required)Details of Event(Required)Interpreter PreferencesInterpreter Preferences (please list 3 interpreter preferences, if no preference then please indicate below)Do you have a Preference for an Interpreter?(Required) Yes No 1st preferred interpreter2nd preferred interpreter3rd preferred interpreterOrganiser Contact Details(Required)Other Requirements/Special Information(Required)I consent to the sharing of my information by SLIS for the fulfilment of the interpreting assignment and management of the scheme as set out below:(Required) Yes No Data Processing Agreement:(Required) Yes No I consent to the sharing of my information by SLIS to fulfil the interpreting assignment and management of the scheme as set out below: SLIS regards the lawful and responsible treatment of personal information as very important/. Therefore, it ensures that this data is collected, processed, stored and disposed of in line with the EU General Data Protection Regulation 2018 (GDPR). Some or all elements of the process may be undertaken by third parties. In such circumstances it will be necessary for your information to be shared between SLIS, the Interpreting Agency and ISL Interpreters for your application to be processed and fulfilled. Information provided to SLIS will be used in the following ways: To administer and facilitate requests for ISL interpreting in a smooth manner To inform the Agency and Interpreters working under requests on the Scheme For management and reporting purposes Some elements of data provided may be used, in grouped and anonymous form, for research or statistical purposes to inform our funders and other interested parties of SLIS’s achievements and progress. You will never be identifiable from this data Individual ISL Users experience will be used anonymously to help optimise the service delivery.
