Mind at Work - Employment Support
SELF Referral Form - Confidential

The Mind at Work project aims to support individuals to access work, volunteering or training opportunities. The team will offer skills employability skills training, emotional support and mentoring. If you feel this service will be of benefit, please fill in the details on this form and return it to the employment support coordinator at Mind. Do not worry if you are unable to fill in all the details.
If you are supporting someone to access the service, this form is intended to be completed jointly with the person who wishes to register.

Basic Referral Criteria
The Referred Person must meet all of the following criteria:-

  • Unemployed
  • Age 18+
  • Resident in the London Borough of Hillingdon
  • Can travel independently
  • Is motivated towards work, volunteering or training
Applicant's Details
This is a required field
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Emergency Contact Details
Referrer's Details (if applicable)
Other Support (CMHT if under CPA)
Any other information to support referral :

Declaration: By submitting this form, I hereby confirm that, to the best of my knowledge, the details given in this form are true.
I agree that the information that I have supplied be kept confidentially using the guidelines of the Data Protection Act.
This form will be sent to the Employment Support Coordinator when you click on the Submit button.