BIASAN Form - Upcycle

Please only complete this form if you are filling in information about a bike required for a beneficiary from our partners Bradford Immigration and Asylum Support and Advice Network (BIASAN)

BIASAN Bike Donation

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About You

Name of Beneficiary(Required)

First and Last

Phone Number of Beneficiary(Required)

Country of Origin of Beneficiary(Required)

Immigration Status of Beneficiary(Required)

Date of Birth of Beneficiary(Required)

Address of Beneficiary

Street Address Address Line 2 City Post Code

Have you (the beneficiary) cycled before?(Required)

Yes, I’m a confident cyclist

A long time ago – I will sign up for a refresher course

I haven’t cycled before and have another way to get the bike from the shop

When you pick up the bike, we will not be able to provide any support with cycling. We encourage you to sign up for a course with our Partner Capital Cycling. We will send details once the form has been completed.

What challenges do you (the beneficiary) currently face with transportation (e.g., cost, time, accessibility)?(Required)

What do you (the beneficiary) hope to achieve or improve by having a bike?(Required)

How do you (the beneficiary) think having a bike will make a difference in your daily life?(Required)

Contact details for BIASAN contact(Required)

Please include your name, phone number and email so we can contact you to arrange a pickup time.