Referral Form | East to West European Association

Urgent safety: ETWE Association is not an emergency service. If anyone is in immediate danger, call 999. If urgent medical help is needed but it is not a life-threatening emergency, contact NHS 111. If it is not safe for us to contact the person directly, do not use this form. Email referrals@etweassociation.org with your own contact details only, and we will agree a safe way to communicate.

Who we can support

ETWE Association supports children, women, families and individuals in need, with a particular focus on Eastern European communities in the UK. Please check that:

The person or family lives in the United Kingdom.
They need community guidance, signposting, integration support, education or training, or support relating to children, young people, women or families.
They, or where appropriate their parent, guardian or authorised representative, have agreed to the referral and to being contacted by ETWE Association.

Does your client meet these requirements? *

I believe they meet the requirements I am unsure, but would like ETWE Association to consider the referral

Your details

Organisation *

Your role *

Your name *

Organisation location *

Your work email *

Your phone number *

Person or family being referred

First name *

Last name *

Age group *

Town or postcode area *

Safe contact number

Safe email address

Best way to contact them *

Communication and access needs

For example, preferred language, accessibility needs or safe times to make contact.

Parent, guardian or authorised representative details

Complete this if the person is under 18 or cannot give consent independently. Include their name, relationship and safe contact details.

Support needed

What kind of support are they looking for? * Brief reason for the referral and support requested *

Include only information relevant to the referral. Do not provide unnecessary medical, immigration, financial or criminal-record information.

Safety and safeguarding

Are there any known safeguarding, safety or contact risks? * Relevant safety information

Include only what ETWE Association needs to make safe contact and assess the referral. Do not use this form for an emergency.

Consent

I confirm that the person has agreed to this referral and to their relevant information being shared with ETWE Association. If the person is under 18 or cannot consent independently, I confirm that appropriate consent has been obtained from a parent, guardian or authorised representative. * I confirm that, to the best of my knowledge, the information is accurate, relevant and limited to what ETWE Association needs to consider this referral. *

Personal information will be handled in accordance with our Privacy Policy and Safeguarding Policy. We may contact the referrer for clarification. We will obtain any additional consent required before sharing information with another organisation.

Refer Someone to ETWE Association

Who we can support

Your details

Person or family being referred

Support needed

Safety and safeguarding

Consent