Student Services - Online Referral - Confetti

Student Support Team – Referral Form

If you would like to access support or would like to refer a friend/peer, please fill in the relevant form below. Please be aware that Student Services are available from 08:30-5:00pm, Monday-Friday and will contact you during these hours only. If you refer someone else, we may contact you directly for further clarification, where needed.

If you or someone else is at serious risk outside of these hours, please speak with a trusted adult, such as parent or guardian, contact your GP during their usual working hours, present at your local A&E Department or dial 999 for the relevant service. You can also search for your local urgent Mental Health helpline here: https://www.nhs.uk/service-search/mental-health/find-an-urgent-mental-health-helpline

Your name*
First Last
Your email*
Your phone number*
Who are you submitting a referral for?*
- Myself
- Someone else
Date of birth*
MM slash DD slash YYYY
Course name/group*
What issues are you facing?*
On a scale of 1-10 (1 being the worst, 10 being the best), how do you feel you are coping?*
Please enter a number from 1 to 10.
Do you have any external support? Such as counsellors, support workers etc.*
Name of the person you are referring*
First Last
Date of birth of the person you are referring
If known
DD slash MM slash YYYY
The course name/group of the person you are referring
If known
Phone number of the person you are referring
What are your concerns for this person?*
Do they have any external support? Such as counsellors, support workers etc*
Does this person know you are sharing your concerns?*
Any other information

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Student Support Team – Referral Form

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