Make a Workshop referral

Our mission is to transform the life chances of 16-25 year olds who have experienced childhood trauma.

We provide therapeutic life skills workshops for young people in a group setting. We ask you to confirm that the young person has given their consent. You may wish to refer to our information about Adverse Childhood Experiences and their effects here.

If you have not been asked to complete this form by a member of the Life Chance Trust team, please contact us on 01626-244086 or trust@lifechance.org.uk to discuss further.

Please use the secure form below to make a referral.

About the person making the Referral:

Name:

Email:

Phone:

Are you enquiring on behalf of an organisation? If so, please give info:

About the Young Person:

Name

Age and/or Date of Birth:

Gender identity:

Place of residence: (Town / City)

Email:

Phone:

Preferred method(s) of contact:

Text Message

Phone Call

Location of Life Chance Workshop (if known):

Please tell us a bit about the background of the young person that relates to our mission (see above):

Does the young person have any additional needs that may affect their communication with us? Please give details:

Any dietary requirements:

Anything else we need to be aware of:

We will use this information to contact the young person to discuss support. The information the young person agrees to provide will be held securely by the Life Chance Trust in line with the Data Protection Act . Please tick this box to confirm that you have consent from the young person to provide this information.