Page 1

Introduction and Declarations

Thank you for referring your client to Greater Change. This referral form should take approximately 10-15 minutes to complete. Please take the time to complete this form, the more information you can provide now, the quicker we will be able to process your referral.

Greater Change’s approach focuses on ensuring all our personalised budgets are person-centred, with the client’s needs and wishes at the heart of the referral process.

Please try to complete this form together with your client either in person or on the phone with you so they are part of the process. We understand that this isn’t always possible, but our hope is that clients are involved as much as possible in this application and have the chance to shape their personalised budgets. There are also some questions which require the client to self-assess their situation and help us to monitor the impact of this intervention, and these are much easier to complete together with your client.

Privacy  Please see our privacy policy  for information about how we process personal data.

Client Declaration


Support Worker Declaration



Reporting Requirements

An important part of Greater Change’s work is to understand the impact of its financial support. In this referral form, it will ask you a set of impact questions. Greater Change will then contact you again in 6 -12 months with an ‘After’ Impact Form containing the same questions.

Please type your full name to sign this declaration electronically.

Page 2

Referral Contact Information

Please add the contact details of the person making the referral - we will use these contact details to follow up with any further questions or queries relating to this referral. Please do not input the client’s information here.


SW name must be same as your signature.












Page 3

Client's Details and Consent

Client Consent

Please confirm with the client how they would like to answer these questions.

As part of our programmes, we report anonymous data to our funders about how their funding has been spent. By completing this form, you consent to your data being anonymised for this purpose.

From time to time, Greater Change also creates case stories about recipients of personalised budgets to show how the money has been spent. This information might appear in Greater Change impact reports and fundraising applications and reports. Information in this referral form is used to write these case stories. We never share any identifiable information in these reports or applications.


As part of our fundraising efforts, we highlight case stories on our website and social media. Information in this referral form is used to write these case stories. We never share any identifiable information on our website or social media platforms.

Occasionally Greater Change might need to contact you directly to discuss your story, or gain feedback on our service as part of our Alumni Programme.

Client Details


Client name should not match SW name.

Client contact no. should not match SW contact no.


Client email address should not match SW email.



We do take repeat referrals for the same client if needed.









Page 4

Impact Reporting

This next section of questions is for the purpose of impact data collection. Your answers to these questions will not affect our evaluation of this referral for a personalised budget.

Current Housing Status



Employment Status


Income


If you don't know the income, please leave blank and click don't know.

Motivation & Engagement


Self-Care & Living


Social Networks & Community


Mental Health


Substance Misuse




Criminal Justice

We only use criminal justice information for our own impact reporting, all information is anonymised



Financial Resilience


Access to Material and Goods

Please answer the following questions about your client’s access to material goods:







Page 5

The Personalised Budget





Page 6

Financial Information & Feedback



Please use this button to upload relevant invoices for third party payments, confirmation of tenancies, or statements relating to paying bills or debts if you have these available
Please use these buttons to upload relevant invoices for third party payments, confirmation of tenancies, or statements relating to paying bills or debts if you have these available