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Agency Referral Form

Thank you so much for taking the time to complete this form as a referring agency.

Our eligibility criteria for Explore:
* Beneficiaries aged 18+ are invited to apply
* Unemployed or earning less than £17 000 pa
* 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