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Make A Referral

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Main Office Telephone: 0207 278 8939 | General Enquiries: info@onlyconnectuk.org

Make A Referral

If you want to refer someone to Only Connect, then please fill out the form below.

Alternatively email the details to referrals@onlyconnectuk.org

or referrals.oc@oclondon.cjsm.net (secure email)

ONLY CONNECT REFERRAL FORM

If you are referring someone else, please state your name, occupation and contact details *You do not need to complete this if you are referring yourself

Details of Referral (required)

First name

Date of Birth

Last name

Contact Telephone (required)

Gender

Male

Female

Transgender

Non Binary

Prefer Not To Say

Home Borough (required)

Criminal Justice Details

Prison Release Date

Licence/community order end date

Probation officer contact details (required)

For Probabtion Use (If Applicable)

Most recent conviction

Date of most recent conviction

Most serious conviction

Date of most serious conviction

MAPPA Level

Risk of re-offending

High

Medium

Low

Risk of harm to others

High

Medium

Low

Details of risk of harm to others (please provide details if particular risk to staff or to women

Risk of harm to self

High

Medium

Low

Gang affiliations (including any areas that are unsafe)

Any exclusions or restrictions that would affect their work or safety

Thanks for submitting!

Address:

32 Cubitt Street, London, WC1X 0LR

Nearest tube: King's Cross St. Pancras

Registered Charity No.1116147

Private Limited Company No.05848399

Safeguarding Policies

Contact:

If you have any queries please contact

us via:

General Enquiries: info@onlyconnectuk.org

Referrals: referrals@onlyconnectuk.org

Office Telephone: 0207 278 8939

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