Make a Referral | Opportunity and Change

Opportunity and Change Referral form

Opportunity and Change is an employability project for people with multiple and complex needs, delivered by a partnership of community based organisations across D2N2 (Derby, Derbyshire, Nottingham and Nottinghamshire).

The project is part of the Building Better Opportunities (BBO) Programme, funded by the European Social Fund (ESF) and The National Lottery Community Fund.

Eligibility Criteria

The project supports individuals, referred to as participants, experiencing at least two of the following issues:

Being homeless or vulnerably housed
Substance misuse issues
At risk of offending or reoffending
Mental health issues
Domestic Abuse

Each participant must be able to prove they have the Right to Work in the UK and are unemployed or economically inactive.

Participant Referral Information (Please complete this section whether you are referring yourself, or referring someone else):
Name*
First Last
Address*
Street Address Address Line 2 Town / City County Postcode
Email*
Date of birth*
Date Format: DD slash MM slash YYYY
Contact telephone number*
Unemployed or economically inactive?*
Tick two or more complex issues identified:*
- Housing
- Mental Health
- Substance Misuse
- Domestic Violence
- Current or Ex-offender
Please provide a brief outline of the support needs:*
Date completed*
Date Format: DD slash MM slash YYYY
Referring Agency Details (Only to be completed if you are referring someone else):
Referral agency
Contact name
Contact telephone number
Email address
Please provide details of your connection and any support provided to the Participant:

This referral form is also available to download here. You can return the form by email to: opportunityandchange@frameworkha.org or by post to: Opportunity and Change, Val Roberts House, 25 Gregory Boulevard, Nottingham, NG7 6NX. If you would like to discuss a referral or have any questions, please email or telephone: 0115 8504086.

Opportunity and Change Referral form

Eligibility Criteria

Participant Referral Information (Please complete this section whether you are referring yourself, or referring someone else):

Referring Agency Details (Only to be completed if you are referring someone else):