Your Store Referral Form 
Due to the high number of households we are currently supporting, we have a waiting list for assessments and membership. To enable us to reduce this list we are only accepting referrals from professionals and agencies. If you are experiencing food insecurity, please contact a professional or agency, such as a social worker, the Bridge East Midlands, a school nurse, your GP or your local Charnwood Borough councillor etc and they will be able to refer you. If you are a professional looking to refer a client, please enter the details below.

New Referral information as of 22/5/24 Please Read!

Once the Referral has been made you may ask the individual who has been referred to come down to Your Store on a Wednesday Or Friday to complete their signup (Subject to assessment Staff Holiday). 

They will need to complete a sign-up form. This includes filling out a budget form and a personal information form that enables us to support the customers the best way possible.

They will need to bring either their phone with the Universal credit account viewable or print outs/screenshots of their whole payment page statement printout. We need to see how it breaks down and see their Name and registered address to see if they are eligible. Submission of these details does not ensure membership, as all applications are subject to eligibility criteria and thresholds. Our priority is to protect our existing user base and ensure that support reaches those in the greatest need. If the client does not meet the required criteria we would be able to refer to a more appropriate service. 

It is important that the Individual has £3.00 to do a shop at Your Store. We are a Social Supermarket that relies on a small amount of money to keep the project functioning long term. If the Individual does not have the required funds consider referring to a Food bank or sending them to the Bridge to see if they can access emergency support. 



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Please confirm that you are a professional and you are making this referral on behalf of someone you support.   *
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