Does the individual need one to one or group training?*

Can the individual be visited alone?*

Are they a Smoker?*

Are they drugs/alcohol dependent?*

Offensive/aggressive behaviour?*

Other

Does the individual have a Visual Impairment*

Does the individual have Poor Mobility*

Does the individual have a Hearing Impairment*

Does the individual have broadband or connectivity? Please let us know which.*

Does the individual require equipment?*

Reason for referral:

•        Work
•        Volunteering
•        Training
• Other
*

Barriers to work & Vulnerability:

•          Health-related considerations - Learning Difficulty / Disability / Neuro diversity
•        Behavioural considerations
•         Any known past convictions / Ex-Offender
*

Suitability for meeting in

•          closed environment
• open environment
  
*

Any other relevant information