Programmes for Young People Referral Form

Parent/carer, teacher or other professionals, as well as young people themselves, can refer to our young people programmes and services.

Please note for therapeutic counselling services please use our Therapeutic Services Referral form found here.

Referrer information

My details

I would like to refer the following young person

I would like to make a referral to

Referral information

Next Steps

Once you have completed the referral form a member of our youth team will get in touch with you within a week. The staff member will discuss the young person’s needs, whether the indicated project(s) is the correct fit to help meet those needs, and will be able to give further information on the timeframe within which the young person would be likely to access the project.

If this conversation confirms that both parties believe taking part in the project is the best fit for the young person, then the staff member will arrange an opportunity to meet them, and to get a consent form signed by the parent/carer, if under 16 years old).

If both parties do not agree that the project is the best fit for the young person, then the staff member will suggest and give information on another Alchemy Youth project(s) which may be suitable, and/or will signpost to other local services that may be able to provide necessary support.

Confidentiality Agreement

The information provided on this form will be kept securely and confidentially. We share your details with the people providing and funding our service who may use it for monitoring, research and planning purposes. We will not share information that identifies you for any reason other than providing your services.

Our full Privacy Policy is available at