Referral Form - Inspiring Leadership Foundation

1. Are you completing this form for yourself or on behalf of someone else? *

a) For myself

b) On behalf of someone else

c) I am submitting a group referral

To be completed by the applicant:

Filling in this form

To complete the form, we'll need your email address and some basic information to contact you. We'll also ask for a bit about yourself so we can better understand your needs and provide the right support.

Name

First

Last

Date of Birth *

Gender Gender

Location

Email address *

Contact Number *

Which services would you like to use? *

Mentorship

Workshops

Work Opportunities

Access to Learning Materials

Please tick all that apply

What do you want help with? *

Building your confidence and self-esteem

Gaining more control over your life

Achieving financial independence

Finding employment

Improving your education

Tell us how we can help you at the moment. Our services are flexible and tailored to your needs. Please tick all that apply.

Which of these best describes you? *

Experiencing low or no income

Unemployed

Limited access to education

Lacking confidence and self-esteem

Limited control over personal decisions

Financially dependent on others

Facing social or economic barriers

Living in a challenging or unstable environment

Please tick all that apply.

How did you find us? *

Social Media (Facebook, Instagram, Twitter, etc.)

Internet Search (Google, Bing, etc.)

Recommendation from an individual or organisation (create drop down to mention who)

Community Center or Local Organization (create drop down to mention who)

School or Educational Institution (create drop down to mention who)

Flyer or Poster

Event or Workshop

Newsletter or Email

OtherOther

We look forward to supporting you on your journey to a brighter future!

To be completed by referring partner/ by someone on behalf of the beneficiary:

20. Your First Name *

21. Your Surname *

22. Your Contact Number *

23. Email Address *

24. Relationship to the candidate

Your relationship to the beneficiary/ the person you are completing this form on behalf of:

25. Candidates First Name *

26. Candidates Surname *

27. Candidates Mobile Number *

28. Candidates Home Number

29. Candidates Email Address

30. Candidates Date of Birth *

31. Candidates Education *

what are they studying? What are their future education plans?

32. Candidates Qualifications *

What qualifications has the beneficiary earned?

33. Candidates Work Experience *

What work experience does the beneficiary have?*

34. Candidates Strength and Interests *

What are the candidate’s strengths and their interests and hobbies?

35. Candidates Development *

What are the areas the beneficiary like to develop and learn about?

36. Candidates work experience placements *

What type of work experience placements would the beneficiary like us to find for them?

37. Do they need to attend with a parent / carer? *

Yes

No

38. What technology do they have access to? *

Select as many as suitable of:

39. What computer skills do they have? *

They have used MS Office before and feel comfortable using it

They have used MS office before but do not feel comfortable using it

They do not have experience using MS Office

They have used other computer software (please specify) They have used other computer software (please specify)

Select as many as suitable of:

40. Which days/times of the week are they free to attend the masterclasses? *

What type of work experience placements would the beneficiary like us to find for them?

41. Do they need to attend with a parent / carer? *

Yes

No

42. Candidates Personality and Social skills *

Can you tell us more about the candidate’s personality and social skills?

43. Candidates Background *

Can you provide some background information to help us fully understand the candidate's needs (family situation, current living arrangements, difficulties, etc.)

44. Anything Else? *

What else should the team be aware of?

IMPORTANT COMMUNICATION AUTHORISATION

To ensure that we follow the right protocols, please confirm if the Inspiring Leadership Trust (ILT) can communicate with the applicant directly regarding their programme.

Authorisation *

Yes, I authorise the ILF to communicate directly

Yes, the ILF can communicate with the applicant directly, copy the following people on all correspondence.

No, the ILF must use this alternative contact and not communicate directly.

Signature of referring partner *

Clear

To be completed by referring partner/ by someone on behalf of the beneficiaries:

20. Your First Name *

21. Your Surname *

22. Your Contact Number *

23. Email Address *

24. Relationship to the candidates

Your relationship to the beneficiary/ the person you are completing this form on behalf of:

IMPORTANT COMMUNICATION AUTHORISATION

To ensure that we follow the right protocols, please confirm if the Inspiring Leadership Trust (ILT) can communicate with the applicants directly regarding their programme.

Authorisation *

Yes, I authorise the ILT to communicate directly

Yes, the ILT can communicate with the applicant directly, copy the following people on all correspondence.

No, the ILT must use this alternative contact and not communicate directly.

Signature of referring partner *

Clear

Candidate names and details

Candidates First Name

Candidates Last Name

Candidates Phone Number

Candidates Email Address

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Application / Referral Form

If you or a a girl or woman that you know would benefit from our support, please fill in this form.

Sign-Up for the Inspiring Futures Academy

Filling in this Form

To be completed by the applicant:

Filling in this form

To be completed by referring partner/ by someone on behalf of the beneficiary:

IMPORTANT COMMUNICATION AUTHORISATION

To be completed by referring partner/ by someone on behalf of the beneficiaries:

IMPORTANT COMMUNICATION AUTHORISATION

Candidate names and details

Application / Referral Form

If you or a a girl or woman that you know would benefit from our support, please fill in this form.

Sign-Up for the Inspiring Futures Academy

Filling in this Form

To be completed by the applicant:

Filling in this form

To be completed by referring partner/ by someone on behalf of the beneficiary:

IMPORTANT COMMUNICATION AUTHORISATION

To be completed by referring partner/ by someone on behalf of the beneficiaries:

IMPORTANT COMMUNICATION AUTHORISATION

Candidate names and details

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