Healing Together - Reference Request Form

Name of Applicant*

Applicant Facilitator No.*

If the applicant has told you their Healing Together Customer Number, enter it here so that we can match your reference to their application

I don't know the applicant's Facilitator Number

Tick this option if the applicant has not provided you with their Facilitator Number

Referee Name*

Referee Email Address*

example@example.com

Referee Job Title*

Please comment on the applicant’s skills and experience to deliver therapeutic programmes to support children and families access early trauma informed help. Please comment on their approach to supporting children, families, personability and ability to reflect upon their work.

Your Comments*

Confirmation Statements*

If applicable, I confirm as an organisation/line manager the applicant will have the capacity to deliver at least two programmes per year.I confirm I support the applicant to become a Healing Together Facilitator.

Signature*

Print Name*

Date*

DayMonthYear