to allow management of the site

to prevent this message from appearing again

By continuing to use this site you agree to these uses.

Hide this message

What are cookies?

Improving the mental wellbeing of young people

Call us 01633 258741

Inspiring…

Inspiring Hope and Confidence

A blonde boy looking at a sad reflection

A red-headed girl smiling and fluffing her hair

A movable arm

A black-haired boy trying to pick up the red-head

A movable arm

A large boy on an unstable ladder

A movable arm

Home
About Us
Getting Support
Volunteering
Schools
Families
Contact Us

Cymru English

Sidebar links

Changing Minds Referral Form- for information on volunteering only

* Please note *

After the former Changing Minds project funding ended, Newport Mind’s community wellbeing team were able to continue to provide services for young people between the ages of 16 – 25 under the Changing Minds brand. We are currently unsure about the future funding for community wellbeing services and sadly have had to put a temporary hold on referrals to services for young people until the situation is more certain. When we have an update for you, you will be the first to know. Watch this space!

Platfform are funded to provide peer support services for 14 to 18 year olds across Gwent including Newport, see here, for more information.

*If you live in Blaenau Gwent, Caerphilly, Monmouthshire or Torfaen, please click here to find details of your local Mind association who may be able to help.*

Please complete this form as thoroughly as possible and with as much information as you can. Failure to complete with adequate information may result in delays.

Please be aware that you can either complete the form below, complete and send back electronically via email or download as a pdf and print, then return via post to:

Newport Mind
100-101 Commercial Street
Newport
NP20 1LU

or changingminds@newportmind.org

If you would like to talk about this referral with someone please contact us on 01633 258741.

Fields marked • are required.

• Date of referral • Young Person's Name Gender What are you referring the young person for (Please tick all that apply): Young Persons Advisory Panel As a Volunteer Peer Mentor Self Management Courses To receive Peer to Peer Support Receive Transitional Support Please detail nature of transition: If you are a young person completing this form please don’t worry about filling out section 1. 1. Organisation details Name of Referrer Agency Address Town Postcode Email Telephone number 2) Young Person's Details Date of Birth Age Area Newport Monmouthshire Caerphilly Torfaen Blaenau Gwent Address Town Postcode Email address Telephone number Consent- is the young person aware that this referral is beng made? Yes No 3) Key agencies who are working with the young person (if known): Agency Contact name Telephone number Agency Contact name Telephone number Other agency involvement? Give details: 4) Reason for referral 5) What are the desired outcomes of this referral? 6) Is there anything we should know about in order to stay safe around the young person? (for example, potential concerns, dangerous dogs, violent family, previous convictions) Yes No Don't know 7) Any other relevant information regarding the following categories: (If you need any help as a young person with any of the things below please let us know) Language Communication Disability Other

Be in charge of your future & make changes!

1 in 10 young people have a mental health disorder

Registered with the Charity Commission

Lottery Funded

Changing Minds, 2nd Floor, 100 to 101 Commercial Street, Newport, NP20 1LU

Tel:01633 258741 | Fax: 01633 257992 | Email:changingminds@newport-mind.org

2014 © Copyright Newport Mind Site by Care Creative Powered by Arrangement CMS