Referring for Support at The ClementJames Centre

This is a referral form for organisations to use to refer clients for support at The ClementJames Centre.

If you would like to get support for yourself, please click here.

Important updates to our Advice, Employment and Numeracy & Literacy services:

The Advice and Employment services at ClementJames are currently unable to take any new referrals and we will reassess the situation in the New Year. Due to high demand, we are also no longer taking any new referrals for the Numeracy & Literacy service for the remainder of the 2024/25 academic year. We apologise for any inconvenience caused.

The below form can therefore only process referrals for Wellbeing Support. We are also still taking referrals for Early Intervention Support here.

Please use this resource to find alternative support for any Advice issue, e.g. Benefits, Housing or Debt support. Alternative Employment support can be found here, depending on which borough the client lives in: Kensington & Chelsea, Westminster or Hammersmith & Fulham. For other learning centres and tuition services available in RBKC, please see here.

Thank you for taking the time to fill out this referral form. If you need support filling out this form, or receive an error message that does not allow you to submit, 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 both you and your client have read and agree to the terms laid out in it.

Who We Can Support

Please select the borough the client is a resident of or housed in:

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

Please select any of the following that apply to the client:

Receiving benefits

Have a household income of less than £25,000

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

Have a child/ward receiving free school meals

Your Details

It is helpful for us to have your details, should we need to contact you about this referral.

Full Name

Organisation

Other:

Role

Contact Number

How will you still be working with the client being referred to us going forward?

Can we contact you about this referral? We will only do so to discuss details relating to the referral, when such details are needed in order to best support the client.

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

Support Referral

Please note that our Advice and Employment services are currently unable to take any new referrals, as per the message above.

What is the main type of support that you are enquiring about for the client?

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

Client's Details

Please only give us your client's contact details with their explicit consent and after they have read and agreed to our privacy notice.

First Name

Last Name

Date of Birth (dd/mm/yyyy)

Gender

Client's self-described gender, if known:

Ethnicity

Other or client's self-described ethnicity, if know:

Contact Number

House Number & Street Name

Post Code

Client's 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, friend or your GP surgery, for example.

Emergency Contact Full Name

Emergency Contact Number

Client's Language and Communication Needs

We ask the following questions in order to provide the best support for the client throughout their time at The ClementJames Centre. Please provide as much information as you can.

Does the client have any learning or physical accessibility needs that we should know about?

Please provide us with more details:

Does the client have any communication or language needs that we should know about?

Please provide us with more details:

We offer English classes for adults. Would the client like to find out more about how we can support them with this?

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

Submit Your Form

Please submit the form below, after which you will be redirected to our online booking system to book the client in for a triage meeting with one of our advisers.

Please only book the client in for a triage meeting if you have confirmed with them that they can attend the time slot. If you are unable to do so, a member of the team will be in touch within two working days.

At the triage meeting, our adviser will gather more information from the client and triage them to the Wellbeing Team.

Contact Information