Self-referral enquiry form | Share Community

Complete this form if you have a disability and you're interested in attending Share's sites in South West London.

If you are enquiring for a course on behalf of someone else, you need to fill out a Referrer's enquiry form.

Applicant's Personal Details

First Name

Last Name

Which most accurately describes you?

Date of Birth

Street Address

Street Address Line 2

Borough

Town/City

Postcode

Country

Phone Number

Mobile Number

Email

Do you have a disability?

Yes

No

If you have a disability, please tick all that apply

ADHD

Autism

Learning disability/difficulty

Mental health needs

Physical disability

Sensory impairment

Down's Syndrome

Other

There is a cost to attend Share, depending on the number of days attended, do you know how their place will be funded?

Yes

No

Application Details

Have you studied at Share before?

Yes

No

Do you have a social worker?

Yes

No

Share operates across 4 sites, which site(s) are they interested in attending?

Clapham Junction

Brixton

Tooting (horticulture site)

Additional Information