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Home > Working Well Norfolk – Professional Referral Form

Working Well Norfolk – Professional Referral Form

Would you like to refer someone to Working Well Norfolk? Fill in the form on this page to refer someone else to Working Well Norfolk.

A job coach and participant talking whilst sitting at a table.
Working Well Norfolk logo and partners
Funded by UK Government

Please fill in the form below ensuring that all the “Required” boxes are complete. This information is needed for us to assess your eligibility for the programme.

Section 1 – Eligibility and background

Can you confirm that the person being referred is a resident of Norfolk and is not on any other employment programme or receiving employment support except from Job Centre Plus?(Required)
Which of the following best describes the current circumstances of the person being referred? (Select One option)(Required)
Is the person being referred 16yrs or over?(Required)
Which of the three eligible groups applies to the person being referred?(Required)

Section 2 – About the referrer

Name of referrer(Required)

Section 3 – About the participant being referred

Name of participant(Required)
DD slash MM slash YYYY
Participant's email(Required)
Participant's address(Required)
Does the participant have a birth certificate or passport?(Required)

Statement to read by the Referrer to the Participant being referred

Your Personal Data

Seetec is committed to data security and the lawful, fair and transparent processing of personal data. We will process the personal data you provide only for the purposes of joining the Working Well Norfolk Programme and to provide the referrer with updates on your progress.

Your data will be retained only for as long as necessary to complete this process, and if you decide that you no longer wish to join the programme or your referral is not approved, your data will be deleted from our systems within 30 days of notification.

We may retain anonymised data (data which cannot be associated with you) for statistical and reporting purposes.

For further information on how Seetec processes personal data, please see our privacy policy.

By making this referral the referrer confirms that they have explained the purposes for the data sharing by reading the above statement to the Participant being referred and that the Participant has given their consent for data to be shared between Seetec Pluss and the Referrer for the purposes of joining and progressing on the Working Well Norfolk Programme.

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