Referral Form

Before we start...

To check your eligibility for WE Work for Everyone, please tick all that apply:

WE Work for Everyone engages and supports people with a learning difficulty, learning disability and autistic people to identify ways to move closer to the labour market.

I have a learning difficulty, learning disability or am autistic

I have the right to live and work in the UK

I live in either Bristol, Bath and North East Somerset, North Somerset or South Gloucestershire

I am not in employment

I am 16 years or over

I aspire towards paid work

Who is completing this form?

I am completing this form for myself

I am completing this form on behalf of someone else

What is your relationship to the participant?

I’m a parent / guardian / relative / friend

I’m a professional working with this person

Name of referrer

Referrer Phone Number

Referrer Email Address

Name of Organisation? (eg. Temple St Job Centre, BCC team, FE College)

Would you like to receive updates about the WE Work programme?

By ticking ‘yes’ I understand my email address will be added to the WE Work for Everyone mailing list.

Yes

No

Person being referred

Contact details

First Name

Surname

Address

Postcode

Phone Number

Email Address

Date of Birth

Gender

Please tell us the best way to contact you? (tick all that apply)

Phone

Text

Email

Letter

About You

Do you consider yourself to have any of the following? (tick all that apply)

Learning Disability

Learning Difficulty

Physical Disability

Autism Spectrum Condition

Mental Health Issues

Sight Impairment

Hearing Impairment

Other work limiting illness or condition

I do not have a disability

Please tell us anything you think would be useful for us to know about your disability or health needs.

Support services & work

What support services do you currently receive, including any support to look for work?

What sort of work/training would you like to do in the future?

What benefits do you currently receive?

Is there any other information we need to know before meeting with you? For example, how you like to communicate, or your access needs?

Privacy

WE Work for Everyone programme is part-funded by the European Social Fund (ESF) and delivered by Bristol City Council in partnership with WECA (West of England Combined Authority) and Bath and North East Somerset Council, South Gloucestershire Council, North Somerset Council and Weston College.

All information provided will be treated confidentially and in accordance with the General Data Protection Regulation (GDPR) and UK Data Protection Laws (UK GDPR & DPA 2018). It will be stored by the Council and used to compile anonymous statistics to inform the Council and its funding partners. Personal and sensitive information will be used solely for the purpose of equalities monitoring to ensure that everyone is treated fairly.

Your Consent

I have read the above and consent to my information being used in this way.

I give my consent to WE Work to contact referral organisations who can support my enrolment onto the programme e.g. Job Centre Plus, School/College, Social Work teams.

I also consent to sharing the following with WE Work, if they apply to me:

My EHCP (Education Health and Care Plan)

My Vocational Profile

Your name(Required)

Date of Signing(Required)

Signature

If you are unable to use the signature box, leave it blank and we will help you at your first meeting.

Phone

This field is for validation purposes and should be left unchanged.

The website has not been optimised for viewing at this size yet. Please only view the website in a desktop browser, not on a mobile or tablet device.

Referral Form

Before we start...

Person being referred

Contact details

About You

Support services & work

Privacy

Contact us

The website has not been optimised for viewing at this size yet. Please only view the website in a desktop browser, not on a mobile or tablet device.

Referral Form

Before we start...

Person being referred

Contact details

About You

Support services & work

Privacy

Contact us

Sign up for our email