Wheels to Work – Bike offers Please fill in the below form when you have purchased a bike through Wheels to Work, using the £50 discount. Share on Twitter Share on Facebook Before completing the form please view our Privacy Notice. From which organisation are you purchasing your discounted bike today?*Bristol Bike ProjectLife Cycle UKJulian HouseWould you be interested in any additional travel support?Please note that we require at least 1 week of notice to provide this. Accompanied cycle ride Adult cycle training Personalised route planning What is the main reason you require our Wheels to Work bike offer?*To attend interviewsTo attend open days (University or College)Starting a new jobAttending a training courseWork placementAttending regular workplaceOther (please specify below)If other, please specify:Without travel support from Wheels to Work, I would travel to the above by:*DrivingGetting a liftBusWalkingTrainTaxiI would not be able to make the journey without Wheels to WorksupportWhich of the following best describes your situation concerning having a driving license and access to a car?*I have a full driving license for a car and current use of my own/ a shared carI have a full driving license for a car and current use of or access to someone else's carI have a full driving license for a car but do not own of have access to a carI do not have a full driving licenseHow did you find out about the scheme?*Referred by another organisation offering Wheels to Work support, e.g. job centreTravelwest websiteBike provider website/ advertisingWord of mouth, e.g. another Wheels to Work userWheels to Work advertising on buses/ bus information boardsWheels to Work online advertisingWhat proof of circumstance did you provide today to show that you are eligible for Wheels to Work support?*Document from DWP confirming receipt of unemployment benefitsEmployment offer letter issued within last four weeksPay slip or employment contract confirming salary less than the living wage (currently £8.25 per hour)Correspondence from training providerCorrespondence confirming workplacement or apprenticeshipInvitation to job interview (if currently unemployed)No evidence was required - eligibility already checkedAbout youThis section is really important as it helps us to gain a better understanding of the views of different people and how they could be impacted by any changes. This information will remain confidential and will be used for analysis purposes only. Your personal information will not be published and individuals will not be identified. To help us to improve the service we offer now and in the future we will contact you after 13 weeks to gather additional feedback about the service you have received. Full postcode:*To be eligible for the scheme you need to have a postcode that falls within the Bristol City Council authority boundariesFull name:*Telephone number:*Email address:Age:16-1818-2425-3435-4445-5455-6465 or abovePrefer not to answerGender:FemaleMalePrefer not to sayDo you consider yourself to be disabled?YesNoPrefer not to sayIf yes, please specify:Ethnicity:Arab/Arab BritishAsian/Asian British – BangladeshiAsian/Asian British – IndianAsian/Asian British – PakistaniAsian/Asian British – ChineseAsian/Asian British – Other (please state)Black/African/Caribbean/Black British – AfricanBlack/African/Caribbean/Black British – CaribbeanBlack/African/Caribbean/Black British - Other (please state)Gypsy or Traveller of Irish HeritageMixed/Multiple Ethnic Groups – White & AsianMixed/Multiple Ethnic Groups – White & Black AfricanMixed/Multiple Ethnic Groups – White & Black CaribbeanMixed/Multiple Ethnic Groups – Other (please state)White – English/Welsh/Scottish/Northern Irish/BritishWhite – IrishWhite – Other (please state)Other ethnic group (please state)Prefer not to sayIf other, please specify:In order to benefit from the scheme you will need to provide consent for us to process your data*Anonymised data will be processed by the University of the West of England (UWE) to assess the success of the scheme.Please select here to opt in to have your personal data to be held and processed by TravelwestThank you for taking the time to respond to this survey. Please press the submit button below to send us your response. Any personal information that you have supplied will be held by Bristol City Council in accordance with the Data Protection Act. This information will only be used as part of this exercise and personal information will be used as decribed in the privacy notice. This iframe contains the logic required to handle Ajax powered Gravity Forms.