Mentee referral form

This form is designed for schools and partner organisations to refer a young person for mentoring support through the Switch Mentoring programme.

Please complete as much information as possible to help us provide tailored support. All information will be treated confidentially and shared only with relevant staff directly involved in the programme.

If you prefer to complete the form offline, you can download a PDF version here and return it to matt@switchrugby.com.

Referrer Details

Your Name:

Your Role:

Your Email:

Mentee Details

Full Name:
School:
Date of Birth:
Year Group:

Parent Contact Name:
Parent Contact Number:
Parent Email:

Home Address (for pick up/drop off):

Detail of any relevant Medical Conditions?
Detail of any Additional Educational Needs?

School Contact Information

Main Staff Liaison for Mentee:
Role in School:
Direct Line Phone:
Email:
Attendance Officer:
Attendance Direct Line:

Background Information

In this section, please provide information on why the mentee will benefit from mentoring. Please include any challenges they are currently facing both in and out of the school environment and any specific goals you would wish them to work towards.

Background Details:

Primary Goal:
Additional Goal:
Additional Goal:

Mentoring Logistics

Required Start Date:
End Date (if no end date please insert “ongoing”):
Dates when sessions won’t be required (e.g. INSET etc.):

I confirm I am authorised to share this information on behalf of the school/organisation and that it may be used for programme planning and delivery in line with Switch Mentoring’s safeguarding and data protection policies.