Safeguarding Self-Referral Form - Oxford Professional Education

OxPE is committed to keeping all learners, staff and visitors safe. Your safety, wellbeing and welfare are our priority.

This self-referral form allows you to request support if you are experiencing difficulties, have concerns about your safety, or feel you may be at risk of harm. We encourage you to provide as much information as you feel comfortable sharing so we can offer the most appropriate support.

Once your form is received, a member of the Safeguarding Team will contact you to discuss your concerns and available support. All safeguarding concerns are taken seriously and information will only be shared on a need-to-know basis, in line with safeguarding and data protection requirements.

If there is a risk of harm to you or someone else, we may need to share information with relevant agencies or professionals to ensure appropriate support and protection.

For more information, please read our Safeguarding Policy.

First Name(Required)

Last Name(Required)

Telephone(Required)

Email(Required)

Preferred method of contact:

Telephone

Nature of concern

Please tell us about the concern you would like support with:

Nature of concern - more information

Please describe why you are making this referral (Or if preferred you can state your wish to share at a later time when in contact with a member of the safeguarding team)

Do you have any particular preferences or requests in preparation for your contact from the Safeguarding team? For example, a preferred time, gender of safeguarding specialist etc?

Is there anything else you feel the Safeguarding team need to be aware of, to best assess the support required and help our response to this referral?

By submitting this form, I consent to being contacted by the Safeguarding Team. I understand that the information I provide will be treated confidentially wherever possible. I understand that if there is a concern that I or another person is at risk of significant harm, the safeguarding team may need to share information with relevant professionals to keep people safe.(Required)

Confirmed