Getting Support at The ClementJames Centre

This is an enquiry form for getting support at The ClementJames Centre.

If you work for an organisation looking to refer a client for support at The ClementJames Centre, please click here.

If you would like to get Numeracy and Literacy support for your young person at the Centre, please click here to be taken to our Numeracy and Literacy enquiry form.

*Please note that due to increased demand and temporarily reduced capacity, we will not be able to take any new enquiries related to Information, Advice & Guidance Support until Monday 12th June.

If you need an appointment sooner than this, please call the centre on 020 7221 8810 and we can signpost you to other organisations who may be able to provide support. You can also click here to see a list of these organisations.

Thank you for taking the time to fill out this referral form. If you need support filling out this form, please contact reception@clementjames.org or give us a call on 020 7221 8810.

Privacy Notice

At The ClementJames Centre, we’re committed to protecting and respecting your privacy.

Please see our privacy notice attached here, and tick here when you have read and agree to the terms laid out in it.

Who We Can Support

If you do not fit our criteria but would like our help to find an organisation who can support you, please contact reception@clementjames.org or give us a call on 020 7221 8810.

Please be aware that we can only support residents who live in or who are housed in either Kensington & Chelsea, Hammersmith & Fulham or Westminster.

Please select the borough you are a resident of housed in:

We also have criteria that clients need to meet to access support. At least one of the following means that you are able to access support at the Centre.

Please select any of the following that apply to you:

Receiving benefits

Have a household income of less than £25,000

Living in social housing (this includes council, temporary accommodation and housing associations)

Child/ward receiving free school meals

Your Details

Title

First Name

Last Name

Date of Birth (dd/mm/yy)

Gender

Self-described gender:

Ethnicity

Other or self-described ethnicity:

Contact Number

House Number & Street Name

Post Code

How did you hear about The ClementJames Centre?

Please tick here if you would like to be subscribed to our mailing list to hear about future workshops, programmes, events and opportunities at The ClementJames Centre.

There are times when photographs of activities are taken for publicity and marketing purposes. This is really helpful for us to be able to show what we are doing in the community. Please tick here if you agree for your image to be used in this way.

Getting Support

If you cannot find the support that you are looking for but would like our help to find an organisation who can support you, please contact reception@clementjames.org or give us a call on 020 7221 8810.

What is the main type of support that you would like to receive at ClementJames?

The funders of our Wellbeing Support programme ask that we collect information about GP practices. If you feel uncomfortable and would like to discuss this information further, please contact reception@clementjames.org or give us a call on 020 7221 8810.

What is the name of your GP practice?

Other:

Are you employed?

For how long have you been unemployed?

We can only provide support to employed people who are receiving income-related benefits support. Please confirm that you are receiving at least one of the following: Universal Credit, Employment Support Allowance, Jobseeker's Allowance, Income Support, Working Tax Credit.

Please tick here to confirm that you receive at least one of the above.

Please tell us, in as much detail as possible, what you would like support with:

Please select the other types of support that you are interested in receiving at ClementJames:

Wellbeing Support - We support people to be able to look after their own wellbeing and

that of their family and friends

Please select the other types of support that you are interested in receiving at ClementJames:

Employment Skills Programme - We equip people with the skills to feel more job ready and to achieve their employment goals

Your Emergency Contact's Details

In the event of an emergency, it is really helpful for us to have someone we can contact for you. This could be a partner, relative or friend, for example.

Emergency Contact Full Name

Emergency Contact Number

Your Language and Communication Needs

We ask the following questions in order to provide the best support for you throughout your time at The ClementJames Centre.

Do you have any learning or physical accessibility needs that we should know about?

Please provide us with more details:

Do you have any communication or language needs that we should know about?

Please provide us with more details:

We offer English classes for Adults. Would you like to find out more about how we can support with this?

Please tick here if you need assistance to exit the building in the event of an emergency evacuation. Staff will prepare a Personal Emergency Evacuation Plan (PEEP) for you.

Submit Your Form

This form is now finished. Please submit the form below.

Contact Information