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Client and Self Referral Form
Thank you so much for taking the time to complete this form - either as a client or self referral.
Our eligibility criteria for Explore - a Personal Development Programme:
* Beneficiaries aged 18+ are invited to apply
* Those living with mental illness or disability
* Those at risk or having experienced economic or social disadvantage such as: homelessness, drug/alcohol dependency, refugee, ex-offender or victim of domestic violence
* Has a link to Richmond Upon Thames Borough or is from a neighbouring Borough
Please briefly provide some background information on yourself - or your client - and what your / their needs are
Please include referred by, date, name of the organisation and the contact name
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Connecting communities,
helping others.

E: [email protected]

Awaiting charity registration number.