Referral Form

You can make a referral as:

* A Professional

* Parent/Carer on behalf of a young person

* Individual with personal interest.

Referral for Alternative Education

Name of the young person *

Current address *

Postcode *

D.O.B *

School year *

Name of parent/carer *

Relationship *

Mobile Number *

Referrers Name *

Name of Organisation *

Telephone *

Email *

Date *

What is the young person's attendance currently like? *

Does the young person have any additional needs? If yes please state below *

What type of behaviours does the young person exhibit? *

Does the young person need to be constantly supervised *

Has the young person experienced any self harm episodes? If so when was the last instance *

Is the young person known to consume drugs or alcohol? *

Does the young person have a history of missing/absent from home? *

Leave this field empty

Referral for individual - (NEET)

Name *

Address *

Postcode *

Email Address *

Contact Number *

Are you currently out of employment, education or training? *

Which of our courses would you be interested in? *

Basic Hair
Advanced Hair
Blow-Drys
Hair Styling
Hair Extensions
Manicure & Pedicure
Nail Art
Gel Nails
BIAB
Acrylic
Basic Facials
Microdermabrasion
High Frequency
Galvanic
LED therapy
Basic Makeup
Creative Makeup
Special Effects
Stage Makeup
Bridal Makeup
Party Makeup
Lash Extensions
Eyelash Lift & Tint
Eyebrow Wax & Tint
Brow Lamination
Henna Brows
Spray Tans
Massages

Would you be interested in our further support groups? If so, please state below *

Leave this field empty

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