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Employment Training & Housing Options Support project referral form

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You can use this form to contact your learning and careers adviser. Please make sure that you give us as much information as possible. When you click the 'Submit' button at the end an email will be sent to the Learning and Careers Adviser who will contact you to discuss your needs.

The questions you will be asked on this form will depend on whether you are the applicant or a referring authority. Please select an option below and then press the 'Next' button at the bottom of the screen.

Questions marked with a red * are mandatory.

Please select *


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What are you looking for from the service? *



Is this referral from an organisation other than a Local Authority? *


Organisation details

Referring Authority details

Applicant's details

Title *




Sex *


Contact details

Please provide at least one contact telephone number and email address (if known).

What type of accommodation is the applicant currently living in? *












What is the applicant's current employment status? *








Applicant's referral category *






Reasons for referral *
Select all that apply








Thank you for completing this form, if you are ready to send it to an adviser click on the 'Submit' button below. A copy of the form will automatically be sent to the Learning and Careers Adviser who will contact you to make an appointment as soon as possible.
If you have given us an email address on the previous page you will receive a confirmation email from the system.
Signature
Date
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