Referral Form – English at Home – Leeds Asylum Seekers' Support Network

Project you want to refer to:

Click here to see a detailed description of what English at Home offers, and how it works: English at Home

Consent

I confirm that I have read the referral guidance, and consent to my personal details being shared with Leeds Asylum Seekers’ Support Network (LASSN). For more details of how LASSN keeps your information confidential please click here to read our Confidentiality Statement

Contact Details

First Name

Last Name

Street Address

City

Postcode

Email address (if you have one)

UK Mobile Phone Number

Please specify the country code

Date of Birth

Gender

Preferred Spoken Language

Other Languages Spoken

Is an interpreter required for the first meeting?

If you ask for an interpreter, LASSN will instruct an interpreter to contact you so that we can arrange our first meeting.

Country of Origin

Home Office Status

Date arrived in the UK

If you don’t know the exact date, please put 1st January for the year of arrival

Reason for the Referral

Details of other organisations that are currently giving support

Referrer Details

If you are completing this form for someone else, please give us your details – in case we have any further questions.

How do you know the person being referred?

First Name

Last Name

Phone Number

Job Title / Your Role

Group / Organisation

What happens next?

When this form is submitted, it is emailed to the Volunteers Managers at LASSN. You will also receive a copy via email. A Volunteer Manager will be in touch as soon as they can, to let you know what is happening with your referral.