Referral

Please complete this form (or you can ask your referrer to do this for you). Let us know how we can help you improve your health and wellbeing through our projects and support. We are here to help connect you with community groups, provide emotional and practical support, and increase your skills, confidence and wellbeing. We will get back to you as soon as possible.

Name*
First Last
Address*
Street Address Address Line 2 City ZIP / Postal Code
Phone*
Email
Emergency Contact Details
Date of Birth*
National Insurance Number
Ethnicity
Gender

Our Areas of Expertise

Routes to Work	Health and Wellbeing	Volunteering
This is the umbrella name for all employment support, providing in-depth, supportive activities to move you closer to work.	This is the umbrella name for our fitness, mindfulness and creative activities.	This is a great way of developing life skills, work skills, confidence and community. We have opportunities to volunteer in all areas of our work.

What are you interested in?*
- Routes to Work
- Health and Wellbeing
- Volunteering
You can make your own approach to us or be referred:
Who is making the referral?*
- Self-referral
- Department of Work and Pensions / Job Centre
- Adviza (Building Futures)
- One Recovery Bucks (ORB)
Confidentiality / Information Sharing Statement*
I confirm I agree with the Confidentiality / Information Sharing Statement below:
Sharing information about your situation and goals with colleagues and other organisations can help your progress. In some cases our funders require us to share information as evidence of our work. Information will only be shared if it is relevant and will support you on your journey and will only be done with your permission.

Personal details
Your details will be kept electronically on file and will be kept for the period required for monitoring purposes. You have a right under the General Data Protection Regulation to access the personal data we keep about you. Please contact routestowork@oasispartnership.org for details of the process if you want to do this. Also use this email if you want to discuss the deletion of your information.

Occasionally it is necessary to share information to ensure people are safe from harm.

You can find out more at Oasis Partnership – Privacy Policy . You can also ask for a copy of this from our Oasis team.

We like to keep you in touch with everything that is happening at the Oasis Partnership. If you would like to receive general updates please include your email above.
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