Leeds Black Elders

Please complete the referral form below and we will get in contact with you as soon as we can. Alternatively you can download our referral form and post it to us at:

180 Chapeltown Rd,

Leeds,

LS7 4HP

Referral

Referring Agency: *

Referral To: (Service) *

Referral From: (Name) *

Address Line 1: *

Address Line 2:

Postcode: *

Telephone Number: *

Clientele Details

Name: *

Date of Birth: Day Month Year

Gender: *

Ethnicity:

Address Line 1: *

Address Line 2:

Client Postcode: *

Telephone Number: *

Reasons for Referral

Reasons for Referral:

Other Relevent Details

Other relevant details / if any: This is to include any disabilities; obstacles Leeds Black Elders Association might incur i.e. second language, social issues, health issues, substance misuse:

Work Already Undertaken By Referrer

Any work already undertaken by referrer / if any:

Assessments & Referrals

Once contact is made with the Leeds Black Elders Association an initial assessment will be carried out on the service user, this will determine the individual's needs.

Online Application »

Contact LBEA

Tel: 0113-2374332
Fax: 0113-237 4313
Email: contact us via our email form

Address: 180 Chapeltown Rd Leeds LS7 4HP

Here to Stay - Videos

We interviewed our elders about their memories when moving to England

View all videos on the Here to Stay website

Click here to view our
Here To Stay Booklet(PDF)

Get Involved

Leeds Black Elders Association recognises the vital contribution that volunteers can make. We value this contribution and are committed to follow good practice guidelines.

Work For Us » Partnerships »

Referral Form

Assessments & Referrals

Contact LBEA

Here to Stay - Videos

Get Involved

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