top of page

Mentorship referral from

Refer someone you know or work with to the Unchained mentorship programme

What is the name of the person you’re referring?

Date of birth of person you're referring
Month
Day
Year

What is your relationship with the person you're referring?

Please choose
Probation officer
Prison staff
Social worker
Friend
Family member partner

Has this person ever applied to or taken part in Unchained mentorship and/or workshop programmes before?

Please choose
Yes
No
I don't know

When was this person convicted?

Date
Month
Day
Year

What are their convictions for? Please list ALL convictions here:

How long was the sentence?

Is the person you're referring still serving a sentence or have they been released?

Please choose
They're still serving a sentence
They've been released
I don't know

What's the ethnicity of the person you're referring?

Please choose
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
Caribbean
African
Any other Black, Black British, or Caribbean background
White and Black Caribbean
White and Black African
White and Asian
Any other Mixed or multiple ethnic background
English, Welsh, Scottish, Northern Irish or British
Irish
Gypsy or Irish Traveller
Roma
Any other White background
Arab
Any other ethnic group

Do you think their race or ethnicity played a part in the length of their sentence?

Please choose
Yes
No
I don't know

What was their life like before prison?

What do you think led to their conviction or being involvement in crime?

What do they want to achieve from the project?

Have they ever performed live?

Please choose
Yes
No
I don't know

How does writing or performing poetry, rap, bars, or lyrics help the person you're referring to tell their story?

What would you like the person you're referring to achieve from sharing their story?

How confident is the person you're referring with sharing their story with the public?

Please choose
They don't want to
They're not confident
They're not sure
They're fairly confident
They're very confident
I don't know

Is the person you're referring on benefits?

Single choice
Yes
No
I don't know

Please give us any other information you think would be relevant or helpful to us

bottom of page