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If you would like to refer yourself or someone else in to one of our programmes, please complete the referral form below and return to info@r-c-t.co.uk

Adult Referral Form
File Size:	34 kb
File Type:	docx

Youth Referral Form
File Size:	34 kb
File Type:	docx

Connections House
60 Drake Street
Rochdale
OL16 1PA

01706 345111

Make an Enquiry

* Indicates required field

Name *

First

Last

Phone Number *

Use a number that we can contact you on

Email *

It would be really useful to have an up to date email address but don't worry if you don't have one

Please tell us more about your situation so we can refer you to the correct service *

Who are you? Tick all / any that apply *

Agency wanting to refer Female experiencing Domestic Abuse Perpetrator of Domestic Abuse Parent of Child affected by Domestic Abuse Young Person Requiring Support (11-16) Young Person Requiring Support (18-25) Person Requiring Counselling I Want to Volunteer I Want to Fundraise I Want to Donate I Want to Support in Another Way Somebody else

Submit

© 2018 Rochdale Connections Trust| Registered Charity No: 1074736

Contact number: 01706 345111
Email: info@r-c-t.co.uk

© 2018 Rochdale Connections Trust| Registered Charity No: 1074736

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RCT
About
What We Do
Get involved
Contact Us
Directory