Refer a Young Person for Rich Mix New Creatives

All information in this referral form will be treated as confidential. Rich Mix requires this form to be filled out by a youth worker, teacher, parent/carer or any other persons working or in contact with young people. This form is to ensure we have all the necessary information to enable us to work successfully and in the best interests of all the young people who take part in this programme.

Your Details

Name:

First Last

Organisation:

Position:

Email:

Telephone Number:

Connection to the young person:

Young Person's Details

Name

First Last

Date of Birth:

Telephone:

Email:

Which London borough do they live in?

Ethnicity:

Gender:

Please tell us what challenges the young person is facing:

How can the New Creatives programme support them?

Is there anything else you would like to make us aware of?