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REFER YOURSELF

For young people to self-refer to us

Word 'REFERRALS' written on wooden blocks

DETAILS OF REFERRAL

Your First Name

Your Email

Your Street Address

Your Street Address Line 2

Your Date of Birth

What progamme/s are you interested in?

Pathways Employability Programme

Holiday Programmes

Educational Courses

Not sure yet

Additional information

Your Last Name

Your Phone Number

Your Town/City

Your Postcode

What is your current status?

In full-time education

In employment (over 16 hours)

In employment (under 16 hours)

Not in education, employment, or training

Other

How did you first hear about us?

Word of mouth

Search engine (Google, Bing etc)

Instagram/Facebook

Other Social Media

Thank you for referring!

Contact Us

Telephone: 01922 276 162

Email: info@openlensmedia.co.uk

Address: Unit 5, The Tanyard,

65 Lower Forster Street, Walsall,

West Midlands, WS1 1XB

© 2024 by Open Lens Media CIC

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