Programme: MU Alternative Provision 
Thank you for expressing your interest in our services. To help us best navigate what support we can offer to your young person/people, please complete this referral form, and a team member will be in touch with you in due course.

All information shared will be kept confidential and handled in accordance with the General Data Protection Regulation (GDPR).
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Email *
Your Full Name: *
Contact Number: *
Organisation: *
Your Role / Position: *
Type of Referral: *
Group size? (if applicable):
What term would you like enrolment to commence? *
Please select student(s) age range?: *
Required
Does the referred young person(s) have any specific interests or talents in music or creative media? *
If yes please provide details?
Reason for Referral (Please provide a brief explanation of why you believe the student(s) would benefit from participating in our programme): *
Are there any concerns or challenges the student(s) may be facing that you believe we should be aware of?: *
How did you hear of our services?: *
Is there anything else you would like to share with us?
A copy of your responses will be emailed to the address you provided.
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