1Referral Source2Personal Details3About You4Privacy and Consent Referral FormBefore 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 referredContact detailsFirst Name Surname Address Postcode Phone Number Email Address Date of Birth Day Month Year GenderPlease select an optionMaleFemaleOtherPrefer not to sayPlease tell us the best way to contact you? (tick all that apply) Phone Text Email Letter About YouDo 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 & workWhat 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? PrivacyWE 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) First Date of Signing(Required) Day Month Year SignatureIf you are unable to use the signature box, leave it blank and we will help you at your first meeting. PhoneThis field is for validation purposes and should be left unchanged. If you need any help filling in this form, please contact us at weworkforeveryone@bristol.gov.uk or call 0117 922 3330.