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JCP Referral Form

Please note: Certain information is mandatory on this form to ensure we can process your enquiry quickly and efficiently, these fields are denoted by a yellow background.

JCP Referral
Referred By:
Date:	23 May 2013
PA's Name
PA's Email:
PA's Direct Dial

Young Persons Applicant Details
Name:
Address:
Telephone:
DOB:

Groundwork NEET Project/Talk to Us If you are 18-22 years old, not in employment, education or training and are interested in attending a 2 days of FREE outdoor activities, please select a Project date below and we will contact you with more information. If you just want to chat to us about your future please select the best day from the Chat list below.
Dates:


I confirm by submitting this form I am authorising City College Group to view and use this information to assess and support the Young Person with their application to City Horizons. All information will be kept strictly confidential. Please note you must have the Young Persons permission to disclose information enclosed in this form. Please also be aware that we contact your previous school or college for additional or verification of information. If you require further information please contact the City Horizons team by calling 02380 577292 or by emailing referral@southampton-city.ac.uk.