Make a referral

Why we use this form?

BCST aim to provide support as early as possible to individuals vulnerable to radicalisation and extremism. This form is used to assess an individual’s risk and make an initial assessment of the nature and extent of the vulnerability present.

You are advised to complete this form if there are concerns about an individual’s interest in extreme or radical views or behaviour. Completing this form allows us to assess an individual’s suitability for our support services. Any information submitted may be shared with relevant partners, where deemed necessary.

How we protect your information?

All the submissions to our site are treated as confidential. We will not share your information outside of the BHCA team unless we have your permission to do so.

Please be aware that the only exception to our best practice above, relates to safeguarding guidelines. This means that information may be shared if any detail provided highlights potential risk to the individual or others.

For further information about our BHCA Privacy Policy and our BHCA Safeguarding Policy, please see the links in the Footer of this website.

This is an online referral form, if you have any questions about completing this form please send your questions using the following email address supportteam@bradfordhatecrimealliance.org.uk

BCST Referral form

Date of referral*

Client Full name*

First

Last

Date of birth*

Gender*

Client Home Address*

Postcode*

Contact Telephone number*

Email address*

Parent(s) / Guardian details

Parent(s) / Guardian 1 details

Parent(s) / guardian(s) 1 name

If applicable

First

Last

Contact number

Email address

Postcode

Parent(s) / Guardian 2 details

Parent(s) / guardian(s) 2 name

If applicable

First

Last

Contact number

Email address

Postcode

Referrer

Organisation or School*

Single point of contact within organisation or school

Name, contact details, email

Nature of concern

Please provide as much detail as possible - full details of issue, vulnerabilities etc.

Actions taken so far to address concerns

Any other agencies involved in this referral

This field should be left blank