24-25 Manchester ESOL referral form

This form should be used for referring your customer/ claimant to an ESOL assessment with the Manchester ESOL Advice Service. We will contact your customer to arrange an ESOL assessment and discuss any suitable ESOL courses.

Only one referral form needs to be completed per customer/claimant.

ESOL course providers only- click on this link for a progression form

1. Referral / claimant's full name and contact details:

They must be at least 19 years old unless they are an Unaccompanied Asylum Seeking Child under 18.

*

First name	*
Surname	*
Postcode (must be a Manchester resident)	*
UK mobile number	*
Email address (if known)
NI number (JCP referrals only)

Are you referring a 16-18 year old Unaccompanied Asylum Seeking Child? *

Yes
No

2. Which organisation are you referring from ?
*

Other referral organisation:

3. Your contact details (please note we need these details to keep a clear record of who has made the referral and also if we need to contact you):

*

Name	*
Email address	*

Please provide any additional comments that may help with the assessment (there's no need to specify your client's 1st language):

4. I confirm that the customer/ claimant has indicated their interest in applying for an ESOL course and has asked to be contacted about it. Please note, we will not be able to progress this referral without the customer's/claimant's agreement for Manchester ESOL Advice Service to contact them. *

Yes
No

Data protection statement: The personal data you've provided will be kept securely by Manchester ESOL Advice Service in accordance with the relevant data protection legislation including the GDPR 2018. Our Privacy Notice which explains how we hold, use and protect your data can be found here:
ESOL Advice Service Privacy Notice

If you have any queries, please contact us at esol@manchester.gov.uk

1. Referral / claimant's full name and contact details:They must be at least 19 years old unless they are an Unaccompanied Asylum Seeking Child under 18. *

Are you referring a 16-18 year old Unaccompanied Asylum Seeking Child? *

2. Which organisation are you referring from ? *

3. Your contact details (please note we need these details to keep a clear record of who has made the referral and also if we need to contact you): *

4. I confirm that the customer/ claimant has indicated their interest in applying for an ESOL course and has asked to be contacted about it. Please note, we will not be able to progress this referral without the customer's/claimant's agreement for Manchester ESOL Advice Service to contact them. *

1. Referral / claimant's full name and contact details:

They must be at least 19 years old unless they are an Unaccompanied Asylum Seeking Child under 18.

*

2. Which organisation are you referring from ?
*

3. Your contact details (please note we need these details to keep a clear record of who has made the referral and also if we need to contact you):

*