Channel/Prevent referral form

Details of person being referred

This information will not be used to assess whether a referral should be adopted. Any personal data provided may support Equality Act obligations. Please only provide personal data if this information is already known from an official source or was provided by the person in question.

Is the individual... Required
Do you know their date of birth or approximate age? Required
Gender Required
Ethnicity Required
Immigration status? Refugee status? Asylum claimant? Please describe.