Referrals
Please use this link to refer an individual to one of Better Connect's programmes of support. We will review the information and see which programme and which partner is best to support the individual. The partner will then contact them to arrange the first appointment. This form can be used to self-refer.
If the person being referred is not currently in work, is work a goal for the future (including long-term)
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Please Select
Yes
No
Please confirm if the person referred has right to work in the UK
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Please Select
Yes
No
We do not currently have programmes for people who don't see work as a realistic future goal - but please check back with us in future.
Right to work is a necessary requirement for all our programmes.
Date referral made
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-
Month
-
Day
Year
Date
Name of person being referred
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First Name
Last Name
Age of person being referred
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Town/City/Village referred person lives in
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Phone Number of person being referred
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Please enter a valid phone number.
Email address of person being referred
example@example.com
Which of the following describes the current employment status of the person referred?
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Please Select
Unemployed - Works zero hours per week, actively seeking work and available for work (NOT ELIGIBLE FOR OUR CURRENT FUNDING)
Economically inactive - Works zero hours per week, not actively seeking work and not available for work
Employed with barriers - Working any hours at all, or employed but on sick leave, typically with barriers to work
Please tick which barriers the person being referred is facing:
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Mental Health
Physical Health/Work Limiting Conditions
Financial Exclusion
Caring/Childcare Responsibilities
Skills Gap/Lack of Qualifications
Substance/alcohol misuse
Homelessness/vulnerably housed
Ex Offender/Criminal record
Domestic Abuse
Isolation
Neurodiversity
Other
What would the person being referred like to achieve as a result of support?
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If there are any safeguarding risks to raise, please detail them here:
Any other information (e.g. preferred contact method)
Name of referrer
*
If self-referring, you can just put 'self' or type your name again
Phone Number of referrer
*
Please enter a valid phone number.
Email of referrer
*
example@example.com
Submit
Should be Empty: