Student Services (Safeguarding and Wellbeing) Referral Form
Use this form to refer learners to Student Services where you have a safeguarding, mental health or wellbeing concern.
If you're concerned that you or someone else isn't safe or is at risk of harm or harming someone else, please call immediately on 07824 383638 (Daniel Bristow-Bailey) or 07776 202409 (Chris Nixon).
If you're a student at WLC, you can use this form to refer yourself.
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Email *
Learner Name *
Learner ID number *
Learner age *
College Site
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Curriculum Area *
Who is making this referral? *
How should we contact the learner? *
Learner's phone number
Learner's email address
What are your concerns about the learner? *
Is the learner getting any support from outside the college (e.g. mental health team, social services, counseling)? if so, what kind of help are they getting?
Do they have an EHCP? *
Is there any other information that we should know?
What is your relationship to the person you're referring?
Referrer's Name
Referrer's Phone Number
A copy of your responses will be emailed to the address you provided.
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