Glasgow City Council
> Glasgow Helps Referral Form

Glasgow Helps Referral Form

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

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