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Glasgow Helps Referral Form
Glasgow Helps Referral Form
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You can apply directly for fuel support here
here
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Find out what we do with your data. Read our
Privacy Statement
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Who are you making this referral for?
Who are you making this referral for?
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Myself
Someone Else
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Which organisation do you work for? For example, Charitable Organisation, HSCP, GCVS, GCC Staff, Other (e.g. family member, staff member of another organisation)?
What is your role within that organisation?
Has the Citizen consented to a referral being made on their behalf?
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Yes
No
Your First Name
Your Surname
Your Phone Number
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Citizen Details: First Name
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Citizen Details: Surname
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Citizen Details: Date of Birth
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Citizen Details: Contact Phone Number
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Citizen Details: Email
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Citizen Details: Address 1
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Citizen Details: Address 2
Citizen Details: Address 3
Citizen Details: Town/City
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Citizen Details: Postcode
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What support can Glasgow Helps provide?
Why is the referral being made?
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Food Support
Help with Money
Mental Health Support
General Health Support
General Advice
Fuel Support/Fuel Advice
Other
Has the citizen engaged with Glasgow Helps before?
Have you spoken with Glasgow Helps before?
In touch before
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Yes
No
I Don't Know
Do you require assistance, such as an interpreter or sign language?
help
Yes
No
Language spoken
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Any other information
How did you hear about Glasgow Helps?
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