Rochdale ESOL Referral form

This form should be used for referring your customer/ claimant to us so that we can contact them to arrange an ESOL assessment and discuss any suitable ESOL courses.
 

1. Referral / claimant's full name:

Rochdale ESOL logo
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Any comments or extra details that may help with the assessment:

 

 

2. Which organisation are you referring from? 

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3. Please tick if you would like to be updated on the referral *

 

4. 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):

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5. 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 Rochdale ESOL Advice Service to contact them. Please do not continue with this form without discussing this first with your customer/claimant, and that the customer/claimant is aware you may ask for an update from us about the referral.  *

 
Data protection statement:  The personal data you've provided will be kept securely by Rochdale ESOL Advice Service in accordance with the relevant data protection legislation including the GDPR 2018.

If you have any concerns about how your personal information is used, please contact us at esol@rochdale.gov.uk