DUS Referral Partnership Request Form

Digital Urgent Support (DUS) is an early‑intervention service delivered by Move Connect Escape Trust (MCE). DUS provides short‑term digital crisis support, wellbeing triage, and practical guidance to people who are struggling to access essential online systems during moments of stress, vulnerability, or digital exclusion.

DUS operates through a partnership model. Approved partner organisations can request DUS support for their venue, service users, or community sessions. Once a partnership request is approved, your organisation can:

Book a Digital Support Officer (DSO) to attend your venue
Offer in‑person digital crisis support to people who need urgent help
Provide guided digital tasks (benefits, housing, health, safety, finance)
Support individuals who are digitally excluded or overwhelmed
Access short‑term digital wellbeing check‑ins and follow‑up coordination
Receive safe signposting and escalation where safeguarding concerns arise

DUS sessions can be delivered during:

Drop‑ins community groups
Outreach events
Warm spaces
Wellbeing hubs
Digital Crisis‑support sessions
Partner‑led activities

The partnership does not replace your organisation’s safeguarding or support responsibilities. Instead, it gives your team access to a trained Digital Support Officer who can provide specialist digital help during critical moments.

Submitting this form begins the partnership process. If approved, MCE Trust will arrange an onboarding call with your lead contact to confirm:

how DUS works
how referrals are made
how to request a Digital Support Officer
session scheduling
safeguarding and privacy expectations

Notice: Do not include information about individuals in this form. If a partnership is agreed, DUS will explain the appropriate referral process separately. Do not use that process for an emergency or immediate risk.

I understand that this form is only a partnership request and must not be used to send information about an individual or to request emergency help.

Organisation Name

Organisation Type

Sector / Area of Work

Organisation Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Organisation Website (if applicable)

Organisation Email (e.g., info@... or referrals@...)

example@example.com

Organisation Phone Number (main line or switchboard)

Please enter a valid phone number.Format: (000) 000-0000.

Contact person's name

First NameLast Name

Job title or role

Contact email

example@example.com

Contact phone number

Please enter a valid phone number.Format: (000) 000-0000.

Preferred way to contact you

Briefly describe why your organisation is interested in a partnership with DUS

Helper: Do not include personal or sensitive information about any individual in this form. This section is for organisational context only.

When are your sessions or services usually available?

Rows	AM	PM
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Approximately how many people might you refer to DUS in a typical month?

What makes you interested in referring people to DUS, and what would help the partnership work well?

I confirm that I am authorised to submit this partnership request on behalf of the organisation named in this form.

I confirm that the information I have provided about our organisation is accurate to the best of my knowledge.

I understand that submitting this request does not establish a partnership, guarantee approval, or guarantee that DUS will accept any future referral.

I will not enter or send personal, confidential, or sensitive information about a person who may need support through this partnership request form.

Before making any referral, our organisation will explain the referral to the person, check that they want to be referred, and follow applicable law and our own policies.

Our organisation is responsible for ensuring it has an appropriate lawful basis and any required permissions to share information in a referral.

Our organisation will use only a DUS-approved referral route and will not send personal information through ordinary email or this partnership request form.

Our organisation will follow its own safeguarding, confidentiality, data-protection and information-security policies when discussing or making referrals.

I have read the DUS privacy notice: Mcetrust.org.uk .

DUS Referral Partnership Request

Before you complete the form, get to know what is DUS and what we offer

Start of Form

Your Service and Referral

Partner declaration