The Project - Welfare Benefits Referral Form

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Due to increased workload, we aim to contact a referral within 10 working days but it may be over 3 weeks until an available appointment. Therefore, if somebody has a form they require assistance filling in please advise them to call the issuing department and request an extension. This form is for both professionals and people making a self referral.

Section/Page 1 is for professionals and agencies making a referral on behalf of someone they are currently supporting. The person you are referring must be aware and give permission for you to make this referral on their behalf.

Self referrals - If you are completing this form for yourself, please input your email address below and then skip to section/page 2.

We are currently working with the following groups of people, please confirm which criteria you meet

(if you do not meet the criteria we are unfortunately unable to work with you and you may not be contacted back)

This is a referral from a CMHT or social prescriber - over 18s with mental health in Selly Oak or Northfield

Northfield Referral

Families and Young People (16-25) in Selly Oak and Northfield (waiting list in place)

Redditch Referral

Debt Advice (Sutton Coldfield Centres of Warmth only)

If you are making this referral on behalf of someone please provide your name

Organisation or relationship to person being referred

Contact Number

Please indicate what capacity you are working with the person you are referring and what support you are providing.

Please detail any information that we may need to know such as risks, special assistance requirements etc

Please tick to confirm that you have permission to make this referral. Please note we do not provide updates on progress of the referral particularly without the explicit consent from the person being referred.

I have permission to make this referral

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