Make a Referral

One-Eighty takes its responsibility regarding the protection of personal privacy very seriously. All personal data will be held and processed in accordance with the requirements of the 1998 Data Protection Act.

Fill out ALL the fields – all completed referrals will receive a response within 48 hours of receipt. Referrals will be allocated to workers using the Traffic Light safe guarding framework below. Families must be notified and must give verbal consent for a referral (and information sharing). Once the referral ha been accepted they will be required to give written consent.

The Traffic Light System

RED (high level vulnerability)

Criteria

What the Young Person/school will receive

AMBER (medium level vulnerability)

Criteria

What the Young Person/school will receive

GREEN (low level vulnerability)

Criteria

What the Young Person/ school can receive

Referral Form

If you submitted a referral using this form before the new year, we recommend contacting the One Eighty team at admin@one-eighty.org.uk
Referrer's Details
Young Person's Details
Young Person's Risk Factors Tick all that apply
Family Risk Factors Tick all that apply