Referrals form | The Pankhurst Trust and Manchester Women's Aid

If you would like to make a referral for support for yourself or someone else, please fill in this form and click ‘submit’ at the bottom of the page

**IF YOU ARE AN AGENCY MAKING A REFERRAL FOR A CLIENT, WE CANNOT ACCEPT THIS WITHOUT A DASH. PLEASE EMAIL REFERRALS@MANCHESTERWOMENSAID.ORG INSTEAD**

Is this referral for yourself or someone else?

Myself

Someone else

Name

Contact number

Contact email

First half of post code. (We can only support those living within the Manchester City Council District. If you do not live in this area, please contact the 24-hour National Domestic Abuse Helpline on 0808 2000 247)

Safe time to call?

Is it safe to leave a voicemail?

Yes

Is it safe to text?

Yes

Please tell us what you need help with?

If you would like to make a referral for support for yourself or someone else, please fill in this form and click ‘submit’ at the bottom of the page

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