NOVA partner referral form

This form is for use by any statutory or non-statutory organisation

Please complete if you want to make a referral to initiate contact and seek appropriate support and advice for a veteran in the justice system.

We will contact the person who has been referred for an initial discussion within two working days of receiving the referral.

Page 1

Part One: Referrer contact details

Referrer name

Referrer organisation

Referrer contact number

Referrer email

Page 2

Part Two: Details of the veteran you are making a referral for.

Veteran’s full name

Date of birth (DD/MM/YYYY)

Service number

Veteran’s contact number

NHS number

Email address

Veteran’s current address

Please note:

If you are making a referral on behalf of someone else, please make every effort to obtain their consent prior to completing this form. If you feel there is a risk to themselves or others, consent to refer is not required. Please state below if the person is a risk to themselves or others

Additional comments and risk information

Immediate support needs

Scheduled to appear in court/may be recalled or remanded to prison

Page 3

Part Three: Consent to refer

About your personal information

How we will process your request

The Forces Employment Charity is committed to protecting the privacy and security of your personal information and ensuring that all personal data is processed in accordance with UK data protection legislation.

The information provided in this referral form will be used to determine how the Forces Employment Charity can best support the individual. By ticking the box below and submitting the referrals form, you consent to the referral being made and the information provided within this form being shared with the Forces Employment Charity to facilitate access to support.

You may be asked to provide additional information to support in the needs assessment of the individual.

Yes, I consent.

Veteran’s name

Date: