Talk Listen Change

Home
About
Covid-19
Blog
News
Quick Book
Contact Us
Support Us

TLC: Talk, Listen, Change: The home of safe, healthy, happy relationships

We have over 35 years' experience in supporting relationships in Greater Manchester

We are an award-winning charity that delivers over 13,000 sessions of support every year.

We are BACP and RESPECT Accredited

Find out more Donate

Welcome to our online referral form for The Right Angle. By submitting the information below, someone from our team will contact you regarding this referral.

Submission Preview

…

REFERRER DETAILS

Name:*

Referrer Organisation:*

Referrer Phone Number:*

Referrer Email Address:*

PUPIL DETAILS

Pupil Name:*

What school is the pupil enrolled at?*

If pupil is LAC, which Virtual School Team are they under?

Please note: only LAC pupils from Tameside, Rochdale and Oldham Virtual Schools are automatically eligible to take part in The Right Angle. If your pupil is under another virtual school, please contact us to discuss their needs.

Pupil Date of Birth:*

Pupil Gender:*

Pupil Ethnicity:*

Pupil Year Group:*

Pupil SEN Status:*

Pupil Premium Status:*

Pupil Attendance %:*

Is the child involved with any of the following agencies? Please tick as appropriate:*

Child Protection Plan

Child In Need

Early Help

None at Present

Does the young person know this referral has been submitted and are they happy to participate?*

Yes

Does the parent/carer know that this referral is being submitted and give consent to intervention?*

Yes

Are there any current or previous risk or safeguarding concerns?*

Yes

If yes please provide any relevant information that will support good safeguarding practice and/or reduce risk to all involved in the project:

PARENT/GUARDIAN DETAILS

We need information on at least one parent/guardian of child in order to refer them to counselling. Please provide this information below.

Name of the child's parent/guardian:*

Home address of the Parent/Guardian:*

Parent/Guardian's Phone Number:*

Parent/Guardians Email:*

If school is closed due to Covid-19 does the young person have a private space to access online counselling / tuition?

TUITION DETAILS

Pupils are eligible for 12 hours of tuition in either Maths OR English

Please indicate requirements:*

Maths only

English only

Current School Attainment (eg. GCSE current grades, most recent mock exam) for English:*

Current School Attainment (eg. GCSE current grades, most recent mock exam) for Maths:*

COUNSELLING DETAILS

Reason for counselling referral:*

Are there any ongoing or historical mental or physical health difficulties that we should be aware of?

The Importance of Taking Breaks: What does that look like for me?

Lockdown Me Vs. New Normal Me: What's Changed?

My Lesbian Wedding: Guest Blog by Joni Fox

Send us a Message

Your name Phone

Email address Preferred contact method

Message

Thanks for your enquiry

We will contact you as soon as we can

Registered Office
Floor 5, Trafford House
Chester Road
Manchester
M32 0RS

Telephone
0161 872 1100

Email
enquiries@talklistenchange.org.uk

Working Hours
Mon-Fri 09:00 - 21:00
Closed Sat & Sun

Company Number: 1559314 Charity Number: 512710

T&Cs
Privacy Policy
Cookies
Sitemap
Privacy Notice