Building Better Opportunities Stafford and South Staffordshire Referral Form
Please use this form to make referrals into the BBO programme. We aim to make initial contact with the participant to discuss the project within 2 working days. They will then be contacted by a BBO advocate to arrange a meeting within 5 working days.
Building Better Opportunities Stafford and South Staffordshire is a £2.3m programme, which is funded by the Big Lottery Fund and European Social Fund, and is managed by Business Enterprise Support and delivered by 16 partners across the south of the county.
Section 1: Participant's Information
Please complete the first section with the participant's information.
18 to 29
30 to 49
50 to 64
65 and Over
Address (inc. Postcode)
Is support required with any of the following? Please tick all that are appropriate.
Self Care and living e.g preparing meals, able to heat home.
Managing Money e.g debt issues, budgeting.
Social Networks and Relationships e.g feeling lonley, isolated.
Drug and Alcohol issues
Physical Health e.g disabilities, health issues.
Emotional and Mental Health e.g Anxiety, Stress, Depression.
Basic Skills e.g problems Reading, Writing, Struggles with Maths.
Getting a Job e.g struggles to search or apply for jobs
Housing e.g accommodation not meeting needs, unable to pay rent on time.
Section 2: Appointment Details
If a direct appointment has been made, please give the date.
Unable to make appointment, please contact participant.
Section 3: Referrer's Information
Please complete the second section with the referrer’s information if you are referring from a Building Better Opportunities partner or another organisation. If you are self-referring you can leave this section blank.
If you are an organisation, referring on behalf of someone else. Please confirm that you have read the following statement to them and they are aware their information will be shared.
By submitting this form, you consent that information held within it may be shared with Building Better Opportunities partners or other organisations used by the Building Better Opportunities programme.
I am completing this form on behalf of someone else, and I confirm that I have read this statement to the person, and they have given consent to their information being shared.
I am completing this form on behalf of myself, and I confirm that I consent to my information being shared.
I confirm that I, or the person being referred is not in any form of paid employment.
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