2024-25 Stockport 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.
Only one referral form needs to be completed per customer/claimant.

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

*

First name	*
Surname	*
Postcode (must be a Stockport resident)	*
UK mobile number	*
Email address (if known)
Date of Birth	*

Any relevant comments or additional comments that may help with the assessment:

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):

*

Name	*
Email address	*

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 Stockport 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.
*

Yes
No

Data protection statement: The personal data you've provided will be kept securely by Stockport 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@stockport.gov.uk

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

Any relevant comments or additional comments that may help with the assessment:

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): *

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

*

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):

*