One-Eighty Summer Project Referral Form

Fill in this form if you want to share with One-Eighty the details of a young person that you would like to refer. After completing the form, click submit and your referral will receive a response within 48 hours of receipt. We will then give a response as to whether the initial assessment indicates that our services are suitable.


One-Eighty takes its responsibility regarding the protection of personal privacy very seriously. All personal data will be held and processed in accordance with the requirements of the 1998 Data Protection Act.

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    Details of Referrer

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    Young Person's Details

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    Referral Information

    Please use the scales below to describe how the young person you are referring to us has been affected by the following factors:
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